Case history
Case history
A 28-year-old man with no previous medical history presents with cough, hoarseness, mild shortness of breath, and headache 1 hour after escaping a fire in his apartment building. He smells of smoke. His vital signs are remarkable for a respiratory rate of 24 breaths per minute, but his pulse oximetry reads 99% saturation on room air. He occasionally expectorates scant amounts of black sputum. He has no facial burns, but his oral and nasal mucosae appear red and somewhat swollen. He has occasional stridor, but his chest is clear on auscultation. He has a second-degree burn on his right hand and forearm. He complains of headache and dizziness, but his neurological examination is unremarkable.
Other presentations
Most patients with inhalation injuries present with respiratory symptoms after an obvious noxious thermal or chemical exposure. However, routine use of certain chemical products in poorly ventilated spaces may irritate the airway and induce respiratory symptoms. Because the exposure was not noteworthy and thus not volunteered by the patient, inhalation injury may be missed. Similarly, carbon monoxide poisoning, when not associated with dramatic exposure such as a fire, may be difficult to diagnose given the non-specific symptom complex (headache, dizziness, nausea).
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