![]() There may be accessory muscle usage, tachypnea, cyanosis, stridor, and rhonchi/rales/wheezing. Physical examination should include looking for facial burns, such as loss of facial and intranasal hair as well as carbonaceous material or soot in the mouth or sputum. In cases where history is limited, some physical examination findings may cue the examiner into possible inhalation injury. Many different etiologies may cause changes in mental status including hypoxia, hypercarbia, or asphyxiant exposure (carbon monoxide, hydrogen cyanide). ![]() ![]() Patients may have systemic symptoms like a headache, delirium, hallucinations, and may even be comatose. Symptoms of odynophagia after smoke exposure should also raise suspicion for a possible inhalation injury. Patients suffering from smoke inhalation may have symptoms of burning sensation in the nose or throat (which is often caused by an irritant chemical toxin), a cough with increased sputum production, stridor, and dyspnea with rhonchi or wheezing. Burn patients may have extensive external injuries, but smoke inhalation may affect those with no outward signs of burns. History taking should be complete and thorough. Pediatric patients also have increased minute ventilation with a higher respiratory rate when compared to adults, thus, increasing the amount of exposure. Children also often hide from smoke or fires thus increasing time exposed. Patients may be unconscious at presentation and interviewing first responders/rescuers may be required. Duration of exposure is often greater for pediatric and elderly patients as often they will have longer exposure due to disorientation or mobility issues. Duration of exposure, the location of exposure (such as if it was in an enclosed space), and any loss of consciousness are all important as well. It is important to elucidate whether the exposure was to smoke, flames, and/or possible chemicals (both industrial and household). Ī high index of suspicion is important for all clinicians to have when evaluating patients for inhalation injury. Most lower respiratory tract injury is from smoke particles and the chemicals that they carry. A direct thermal injury is rare past the vocal cords because even superheated air is quickly cooled by the nasopharynx and oropharynx prior to causing lower respiratory tract injury. Damage to the lung parenchyma causes both epithelial and endothelial damage resulting in pulmonary edema and possibly acute respiratory distress syndrome (ARDS) due to widespread alveolar-capillary leak. Pseudomembranes may also form in the trachea or bronchi causing bronchiolitis obliterans and organizing pneumonia. Obstruction of airflow is often the effect caused by tissue edema narrowing the passageways and mucus/blood/fluid impeding airflow. Chemical toxins that have low water solubility may reach the lung parenchyma without damage to the airways.ĭamage to airway tissue causes increased mucus production, edema, denudation of epithelium, and mucosal ulceration and hemorrhage. Examples of highly water-soluble chemicals include ammonia and sulfur dioxide. More water-soluble chemicals will often damage the moist mucosa of the upper airway without causing alveolar damage. Chemical toxin/irritants may cause damage to just the airways, just the alveoli, or both. Specifically, water solubility for gases or vapors, and the physical characteristics of the particulates for fumes and aerosols are important for determining the location of the injury. Thermal injury often affects only to the level of the larynx. The location where damage occurs is complex. Inhalation injury affects the respiratory system through damage to the airways (including nasal passages, posterior oropharynx, larynx, trachea, bronchi) or parenchymal damage (alveoli).
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