Inhalational Injury

Inhalational injury may be the most immediately life-threatening manifestation of thermal burns, and initially can be occult. If significant injury to the airway is suspected, the patient should be given humidified 100% O2 until the airway can be directly visualized or secured by early intubation. Carbon monoxide and cyanide exposure should be investigated.

Causes

Fires cause burns and these injuries are obvious but injuries to the lungs and airways from smoke inhalation are often less apparent and may not present until 24 to 36 hours after exposure. Smoke injury accounts for 75% of the deaths related to fire although there may be burns too. Another major cause of serious injury and death related to fires is people jumping from high windows rather than awaiting the arrival of the emergency services.

Symptoms

• Brassy cough
• Hoarse voice

Signs

• Stridor
• Mouth, nose burn
• Airway edema, erythema
• Singed facial, nasal hairs
• Sooty sputum

Treatment

Immediately after injury and on admission to a specialised department, basic measures are essential to take:

• Ensuring free airways - prompt endotracheal intubation: In case of deep skin burns on the neck and trunk, releasing incisions must be made as soon as possible.
• Ensuring adequate ventilation and oxygenation of peripheral tissues: moistened oxygen, artificial pulmonary ventilation in case of respiratory insufficiency.
• Careful analgosedation is essential.
• After intoxication with combustion products: specific antidotes and oxygen therapy.
• Wash unburned skin to remove any remaining toxic residues.