An NEJM Image in Clinical Medicine shows carbonaceous deposits in a man’s airway after a house fire.
Comment
Acute hypoxemic respiratory distress and carbonaceous sputum after a house fire is a clear signal for smoke-inhalation injury. Fire-related inhalation injury is an independent predictor of mortality, along with burn severity and patient age. Injury location (e.g., supraglottis, subglottis, or the rest of the body) matters, as each location has distinct pathophysiologic and management implications. In this case, the patient’s subglottic carbonaceous deposits indicated tracheobronchial injury, placing the patient at risk for airway inflammation and bronchospasm. For additional information about fire-related inhalation injury management, see this consensus guideline.
Comment
Acute hypoxemic respiratory distress and carbonaceous sputum after a house fire is a clear signal for smoke-inhalation injury. Fire-related inhalation injury is an independent predictor of mortality, along with burn severity and patient age. Injury location (e.g., supraglottis, subglottis, or the rest of the body) matters, as each location has distinct pathophysiologic and management implications. In this case, the patient’s subglottic carbonaceous deposits indicated tracheobronchial injury, placing the patient at risk for airway inflammation and bronchospasm. For additional information about fire-related inhalation injury management, see this consensus guideline.