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
Matthew R. Stutz, MD
Fellow
Section of Pulmonary and Critical Care Medicine
Department of Medicine
University of Chicago
Chicago
IL
Disclosures
MRS declares that he has no competing interests.
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.
Acknowledgements
Dr Matthew R. Stutz and Dr Jason T. Poston would like to gratefully acknowledge Dr Karen C. Dugan and Dr John P. Kress, previous contributors to this topic.
Disclosures
KCD and JPK 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
Rabinowitz, PM, Siegel MD. Acute inhalational injury. Clin Chest Med. 2002 Dec;23(4):707-15. Abstract
Miller K, Chang A. Acute inhalation injury. Emerg Med Clin North Am. 2003 May;21(2):533-57. Abstract
McCall JE, Cahill TJ. Respiratory care of the burn patient. J Burn Care Rehabil. 2005 May-Jun;26(3):200-6. Abstract
ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016 Aug;42(5):953-1021.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
Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67.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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