Charles - I do not 'routinely' investigate smoke inhalation unless there are good clinical reasons for concern. Clearly the history is all important.

 

I share Rowley's anxiety re CO poisoning particularly when exposure has not been overt - (e.g. student population presenting with non-specific headache living in rented accommodation....................) Ready access to a CO-oximeter (i.e. linked to resus room blood gas analyser) in the ED is crucial for its timely diagnosis. It continues to be tragically overlooked usually by inexperienced clinical staff who have failed to consider this in the differential diagnosis.

 

In terms of CN poisoning I would very much like access to an limited stock of hydroxycobalamine (ideally held in the ED) but I have yet to persuade our local medicines advisory committee about its merits because of 'lack of evidence' for its therapeutic efficacy in this setting. I would use it in the clinical scenario as outlined by Tim Coats in a subsequent posting on this topic.

 

John Black

 

-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Scott, Charles
Sent: 12 October 2005 11:29
To: [log in to unmask]
Subject: Smoke inhalation & lactate

 

Does anyone routinely measure blood lactate levels in patients involved in fires where smoke inhalation may have happened in the absence of any signs to suggest Cyanide poisoning?  Lactate is part of the investigation on the Toxbase site  (" If lactate concentration > 10 mmol/L in absence of significant burns and after correct of hypotension consider the possibility of cyanide poisoning." sic)

 And do you always measure CO levels in everyone involved in a house fire?

 

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