Toxic Inhalations

Toxic inhalants are often overlooked as a mechanism for lung parenchymal injury, but are relevant in the context of industrial accidents, chemical warfare, and terrorism. This chapter will address chemicals that trigger inflammation, chemical irritants elaborated from combustion or explosion, physical and chemical asphyxiants, as well as radiological dispersion devices, resulting in inhalation of radioactive materials. Common asphyxiants include carbon monoxide, cyanide, and hydrogen sulfide. Irritants can be classified based on water solubility. Key examples include ammonia, riot control agents, chlorine, phosgene, and nitrogen oxides. Vesicants include blister agents such as sulfur mustard. Organophosphates are found in pesticides as well as chemical warfare nerve agents. Finally, radiologic dispersal devices can result in radioactive material that can be inhaled or cause direct effect on the thoracic cavity. Understanding the signs and symptoms of toxic inhalational injury as well as rescue therapies for each of these domains is relevant for every member of the acute healthcare team.