An Anesthesiologist’s Insight: Navigating Toxic Inhalational Injuries and Choking Agents


Toxic inhalational injuries, resulting from exposure to lung-damaging agents, pose a significant threat in various settings. This comprehensive guide covers the clinical-pathological effects, investigations, and medical management of such injuries, emphasizing the importance of understanding mechanisms for optimizing patient outcomes.

Choking Agents (Pulmonary Agents):

Choking agents, or pulmonary agents, are chemical weapons designed to impede breathing, causing fluids to accumulate in the lungs, leading to suffocation. While these agents are highly toxic and not used in daily life, some have industrial applications. Here are examples:

Choking AgentUseApplications
Chlorine GasVarious industriesManufacture of pesticides, rubber, solvents, disinfectant in water.
Chloropicrin (PS)Tear gas, chemical warfareLimited industrial use, primarily as an agricultural fumigant.
Diphosgene (DP)Chemical warfareMilitary applications, not used in daily life.
Phosgene (CG)Chemical warfareMilitary applications, not used in daily life.
Disulfur DecafluorideChemical warfareMilitary applications, not used in daily life.
PerfluoroisobuteneChemical warfareMilitary applications, not used in daily life.
AcroleinVarious chemical synthesisLimited industrial use, including acrylic acid production.
DiphenylcyanoarsineChemical warfareMilitary applications, not used in daily life.

Note: Strict regulations govern the use of these substances to prevent misuse and ensure public safety.

Clinical-Pathological Effects:


  • Massive Pulmonary Edema
  • Bronchiolar Epithelial Damage
  • Emphysema, Atelectasis
  • Darkly Congested Lungs

Clinical Effects:

  • Mucous Membrane Irritation
  • Eye Irritation
  • Respiratory Symptoms
  • Laryngeal Spasm

Clinical Investigations:

  1. Chest Radiograph:
    • Hyperinflation
    • “Batwing” Infiltrates
    • Atelectasis
  2. Arterial Blood Gases:
    • Hypoxia
    • Low PaO2 or PaCO2
  3. Haematocrit:
    • Increased
  4. Pulmonary Function Tests:
    • Peak Expiratory Flow Rate
    • Decreased Lung Compliance
    • V/Q Scanning

Treatment of Toxic Inhalational Injury:

Medical Management:

  1. Terminate Exposure:
    • Remove casualty from hazard
    • Decontaminate liquid agent on clothing or skin
  2. ABCs of Resuscitation:
    • Establish airway
    • Monitor circulatory status
  3. Enforce Rest:
    • Strict limitation of activity
    • Litter evacuation for symptomatic patients
  4. Manage Airway Secretions:
    • Suction and drainage
    • Antibiotics for infections
  5. Prevent/Treat Pulmonary Edema:
    • Positive airway pressure
    • Diuretics (monitor effects)
  6. Prevent/Treat Hypoxia:
    • Oxygen therapy
    • Intubation and ventilatory assistance if required
  7. Prevent/Treat Hypotension:
    • Intravenous fluid administration
    • Pneumatic anti-shock garment judiciously
  8. Steroid Therapy:
    • Considered in specific exposures
    • Bronchodilators and steroids for bronchospasm
    • Careful surveillance due to increased infection risk


Effective management involves prompt recognition, termination of exposure, and tailored medical interventions. A multidisciplinary approach, including respiratory support and circulatory monitoring, is essential for optimizing patient outcomes. Early identification of high-risk cases and appropriate triage enhance the efficiency of medical care. Understanding clinical-pathological effects and utilizing investigative tools guide healthcare professionals in delivering targeted and timely interventions.


Leave a Comment