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Inhalation injury

Last reviewed: 10 Jun 2025
Last updated: 04 Jul 2025

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
Full details

Other diagnostic factors

  • tachycardia
  • hypotension
  • nausea
Full details

Risk factors

  • known inhalation exposure
Full details

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
Full details

Tests to consider

  • pulmonary function tests (PFT)
  • laryngoscopy and bronchoscopy
  • serum lactate
Full details

Emerging tests

  • cyanide level

Treatment algorithm

ACUTE

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

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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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