Section: Veterinary Care In-depth
Diagnosis In-depth Thoracic radiographs (chest X-rays) are taken to identify changes in the lungs, due to smoke inhalation. Chest X-rays may be normal for the first 36 hours so, depending on your pet's condition, your veterinarian may need to take a series of X-rays to document changes and/or the development of pneumonia over a period of several days.
An arterial blood gas allows the veterinarian to assess the pet's oxygenating ability, which is often compromised following smoke inhalation injury. Not only does it help determine the need for oxygen supplementation but may also be helpful in determining the pet's prognosis. Blood gases also provide information about the blood pH (acidity and alkalinity), which can be altered due to respiratory problems or due to shock. Arterial blood gases are not helpful in determining the extent of carbon monoxide poisoning.
Carboxyhemoglobin levels, which is the amount of carbon monoxide in the blood stream, may be measured to determine the extent of carbon monoxide poisoning present in a patient as well as prognosis. Carboxyhemoglobin levels can be measured only at certain hospitals because the test requires special equipment. However, inability to perform this test has no impact on the ability of your veterinarian to provide appropriate care for your pet.
A complete blood count (CBC) may be performed to assess the general condition of a pet and to look for high or low white blood cell counts that may be present with pneumonia.
A biochemistry profile is a blood screen done to evaluate the kidneys, liver and other internal organs, which may be affected due to lack of oxygen or due to shock.
A tracheal wash is done if pneumonia is suspected. In this procedure, the patient is sedated and a small amount of a sterile saline solution is flushed down the trachea into the lungs and then retrieved by aspiration through a syringe. This sample is examined with a microscope to look at the cells (cytology) and to look for bacteria. The sample is also submitted for culture to identify the type of bacteria causing the pneumonia and to determine which antibiotic should be chosen. Cultures generally take three days to process.
A fluorescein stain is performed to look for ulcers on the cornea (surface of the eye). Ulcers are outlined by the green dye and indicate the need for eye medications.
Treatment In-depth
Because many of these patients are experiencing breathing difficulties, the majority of smoke inhalation patients will be placed in an oxygen cage immediately upon presentation to the hospital and prior to a complete physical examination. While your pet is allowed to rest in oxygen, your veterinarian will gather the medical history and then complete the physical examination.
If your pet is in a state of unconsciousness, it may be necessary to place an endotracheal tube (through the mouth into the trachea) and assist the pet to breathe to prevent respiratory or cardiac arrest. If your pet remains unconscious and unable to breathe on his own, mechanical ventilation may be offered, in which a ventilator breathes for the patient. In most instances, however, treatment proceeds at a less frantic pace as follows:
Administration of supplemental oxygen is an essential part of treatment for smoke inhalation injury because difficulty breathing is the main problem associated with this type of injury. Oxygen may be provided by a tube inserted in the nostril and attached to an oxygen line (nasal oxygen), via a facemask or by placing the pet in an oxygen cage. Oxygen therapy may only be required for a few hours or may be necessary for many days depending on the extent of injury and whether the pet develops pneumonia as a secondary problem.
Intravenous fluids are administered to correct dehydration and to treat shock if present. The intravenous line can also be used for administration of medications such as bronchodilators or antibiotics.
Bronchodilators such as terbutaline, albuterol, aminophylline or theophylline are used to dilate the airways, which can be constricted due to irritation from the heat and smoke. Dilation of the airways makes it easier for the pet to breathe.
Nebulization (humidification of the air breathed by the pet) is provided to help the pet mobilize secretions and particulate matter deposited in the airways toward the mouth to be eliminated when the patient coughs.
Pain medication is administered to pets with burns on their body.
Mechanical ventilation may be provided for those patients who breathe with great difficulty despite administration of supplemental oxygen and medications. The patient must be placed under general anesthesia for the duration of time they are on the ventilator. An endotracheal tube is placed and the patient is attached to the ventilator, which breathes for the patient.
Physical therapy is done to help mobilize secretions and particulate matter in the patient's lungs and airways. Changing the patient's position helps with drainage and prevents airways from collapsing. Coupage, or percussion of the chest wall by gently hitting the chest wall with cupped hands, helps loosen secretions and particles that can then be removed by drainage or coughing. Encouraging patients to stand and walk if they are capable is as effective as coupage and frequent position changes.
Eye medications containing antibiotics are used to provide lubrication for irritated eyes and to treat corneal ulcers.
Antibiotics are not administered to smoke inhalation patients unless pneumonia is documented. Administration of antibiotics when pneumonia is not present can cause patients to develop resistant infections.
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