What is the treatment for a patient with propane inhalation?

Treatment of Propane Inhalation

Immediately remove the patient from exposure, administer 100% oxygen via non-rebreather mask or mechanical ventilation, assess for airway compromise requiring intubation, and monitor for cardiac arrhythmias—the primary cause of death in propane inhalation. 1, 2

Immediate Stabilization and Oxygen Therapy

Remove from exposure and begin high-flow oxygen immediately:

• Remove the patient from the contaminated environment and remove any contaminated clothing to stop ongoing exposure 1
• Administer 100% oxygen immediately via non-rebreather mask for spontaneously breathing patients 1, 2
• If mechanically ventilated, provide 100% FiO₂ for 6-12 hours minimum 3, 2
• Continue oxygen therapy even if pulse oximetry appears normal, as propane causes asphyxia by displacing oxygen rather than binding hemoglobin 4, 5

Airway Assessment and Management

Intubate immediately if any of the following are present:

• Severe respiratory distress, altered mental status, or inability to protect airway 1, 2
• Severe hypoxia or hypercapnia on blood gas analysis 2, 6
• Signs of airway obstruction including stridor or laryngeal edema 1, 6
• Loss of consciousness or coma 2

Monitor continuously for delayed airway compromise:

• Reassess airway status regularly during transport and after hospital admission, as edema may develop progressively 3, 1
• Look for dysphonia, wheezing, or respiratory distress as indicators of deterioration 3, 6

Cardiac Monitoring

Propane causes death primarily through fatal cardiac arrhythmias, not simple asphyxia:

• Initiate continuous cardiac monitoring immediately, as propane sensitizes the myocardium to catecholamines and induces ventricular arrhythmias 7, 8, 5
• Obtain baseline ECG to assess for QT prolongation or arrhythmias 7
• Be especially vigilant in patients on psychiatric medications that prolong QT interval, as there may be synergistic arrhythmogenic effects 7
• Monitor for signs of myocardial damage including chest pain, hemodynamic instability, or ECG changes 8

Laboratory and Diagnostic Evaluation

Obtain the following studies:

• Arterial blood gas to assess oxygenation, ventilation, and acid-base status 1, 2
• Plasma lactate level to assess tissue hypoxia and guide management 3, 2
• Carboxyhemoglobin level if co-exposure to carbon monoxide is suspected (e.g., fire scenario) 3, 2
• Toxicology screen via headspace gas chromatography can confirm propane in blood, brain, and lung tissue, though this is primarily forensic rather than therapeutic 8, 5

Specific Antidotes and Advanced Therapies

Hydroxocobalamin is NOT indicated for propane inhalation:

• Hydroxocobalamin should only be given if there is concurrent cyanide poisoning from smoke inhalation (e.g., fire scenario with severe metabolic acidosis and lactate >8 mmol/L) 3, 2
• Do not routinely administer hydroxocobalamin for isolated propane exposure 3

Hyperbaric oxygen therapy (HBOT) is NOT indicated:

• HBOT should not be administered for propane inhalation, as it is only considered for carbon monoxide poisoning in highly selected cases 3, 2
• Propane causes asphyxia by oxygen displacement, not carbon monoxide poisoning 4, 5

Supportive Care and Monitoring

Provide comprehensive supportive care:

• Maintain oxygen saturation ≥90% with supplemental oxygen 1
• Monitor continuously for respiratory deterioration, cardiac arrhythmias, and neurological changes 1, 8
• Assess for signs of cerebral hypoxic-ischemic injury including altered mental status, seizures, or focal neurological deficits 8
• Evaluate for rhabdomyolysis, myocardial infarction, and other complications of severe hypoxia 8

Transport and Disposition

Transfer to appropriate level of care:

• Transport via ambulance with continuous cardiac and respiratory monitoring 1
• Consider ICU admission for patients with significant exposure, altered mental status, cardiac arrhythmias, or respiratory compromise 8
• Arrange follow-up at 1-2 months post-event to assess for delayed neurological sequelae including memory disturbance, depression, anxiety, and motor dysfunction 2

Critical Pitfalls to Avoid

Common errors that increase mortality:

• Delaying intubation when signs of airway compromise are present—propane can cause laryngospasm and sudden airway obstruction 1, 8
• Failing to initiate cardiac monitoring—sudden death from ventricular arrhythmias is the primary mechanism of mortality in propane inhalation 7, 8, 5
• Assuming normal pulse oximetry excludes significant toxicity—propane causes asphyxia by oxygen displacement, not hemoglobin binding 4
• Overlooking the risk of sudden death even after apparent recovery—patients can develop fatal arrhythmias hours after exposure 7, 9, 5