Summary
Definition
History and exam
Key diagnostic factors
- similarity of symptoms to those of others at site of exposure
- cough
- dyspnea
- hoarseness or dysphonia
- headache
- dizziness
- tachypnea
- hypoxia
- facial burns
- upper airway edema
- stridor
- wheezing
- crackles
- loss of consciousness
- seizures
Other diagnostic factors
- tachycardia
- hypotension
- nausea
Risk factors
- known inhalation exposure
Diagnostic tests
1st tests to order
- pulse oximetry
- arterial blood gas
- carboxyhemoglobin (CO-Hb) level
- chest x-ray
- ECG
- cardiac telemetry monitoring
- urine toxicology screen
- serum ethanol level
Tests to consider
- pulmonary function tests (PFT)
- laryngoscopy and bronchoscopy
- serum lactate
Emerging tests
- cyanide level
Treatment algorithm
all patients
Contributors
Authors
Jason T. Poston, MD
Associate Professor
Section of Pulmonary and Critical Care Medicine
Department of Medicine
University of Chicago
Chicago
IL
Disclosures
JTP declares that he has no competing interests.
Cathryn T. Lee, MD, MS
Instructor
Department of Medicine, Section of Pulmonary and Critical Care
University of Chicago
Chicago
IL
Disclosures
CL has received grants from the Pulmonary Fibrosis Foundation.
Acknowledgements
Dr Jason T. Poston and Dr Cathryn T. Lee would like to gratefully acknowledge Dr Matthew R. Stutz, Dr Karen C. Dugan, and Dr John P. Kress, previous contributors to this topic. We would like to gratefully acknowledge the late Dr Ian R. Driscoll, Associate Professor of Surgery and Anesthesiology at the University of Florida College of Medicine and Director of the UF Health Shands Burn Center, for his peer review of this topic in 2024.
Disclosures
MRS, KCD, JPK, and IRD declared that they had no competing interests.
Peer reviewers
Leopoldo C. Cancio, MD
Critical Care Fellow
US Army Burn Center
US Army Institute of Surgical Research
Brooke Army Medical Center
Fort Sam Houston
TX
Disclosures
LCC declares that he has no competing interests.
Rhys Thomas, MD
Honorary Consultant in Anesthesia and Intensive Care
Queen Victoria Hospital
East Grinstead
Honorary Consultant
Royal London Hospital
London
UK
Disclosures
RT declares that he has no competing interests.
Brendan Madden, MD, MSc, FRCP, FRCPI
Professor of Cardiothoracic Medicine
St George's Hospital
London
UK
Disclosures
BM declares that he has no competing interests.
References
Key articles
ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016 Aug;42(5):953-1021.Full text Abstract
Anseeuw K, Delvau N, Burillo-Putze G, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med. 2013 Feb;20(1):2-9.Full text Abstract
Summerhill EM, Hoyle GW, Jordt SE, et al; ATS Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly. An official American Thoracic Society Workshop report: chemical inhalational disasters. Biology of lung injury, development of novel therapeutics, and medical preparedness. Ann Am Thorac Soc. 2017 Jun;14(6):1060-72.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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