History and exam
Key diagnostic factors
common
similarity of symptoms to those of others at site of exposure
If other patients with similar exposure have become ill, it suggests potential for a high-severity exposure in the patient.[1]
cough
A common but nonspecific symptom that may indicate involvement at any portion of the respiratory system.
dyspnea
A common but nonspecific symptom that may indicate respiratory disease, cardiovascular disease (shock), or trauma.
hoarseness or dysphonia
Raises concern for upper airway injury and edema.
headache
In this context, may suggest carbon monoxide toxicity or trauma.
dizziness
In this context, may suggest carbon monoxide toxicity or trauma.
tachypnea
A common but nonspecific sign that may indicate respiratory disease, cardiovascular disease (shock), or trauma.
hypoxia
A common but nonspecific sign that may indicate acute respiratory distress syndrome, cardiogenic pulmonary edema, carbon monoxide or cyanide toxicity, or atelectasis from airways disease.
facial burns
This finding suggests intense exposure to extreme temperatures, raising the likelihood of inhalation injury, specifically upper airway compromise.
upper airway edema
Swelling, ulceration, or burns of the upper airway are frequently predictive of upper airway compromise.
stridor
Inspiratory stridor suggests upper airway edema and upper airway compromise.
wheezing
Airway edema and bronchoconstriction from inhalation injury or exacerbation of chronic obstructive disease is common.
crackles
Atelectasis, acute respiratory distress syndrome, or cardiogenic pulmonary edema can manifest as crackles to lung auscultation.
uncommon
loss of consciousness
Suggests high severity of exposure.
seizures
In this context, may suggest carbon monoxide toxicity.
Other diagnostic factors
common
tachycardia
Nonspecific cardiovascular signs are common and may be present in inhalation injury and related conditions (burns, trauma, and shock).
hypotension
Nonspecific cardiovascular signs are common and may be present in inhalation injury and related conditions (burns, trauma, and shock).
uncommon
nausea
In this context, may suggest carbon monoxide toxicity.
Risk factors
strong
known inhalation exposure
The majority of inhalation injuries occur in the setting of an obvious inhalation exposure, such as a residential fire, workplace fire or explosion, or a chemical leak. Likewise, the onset of symptoms is acute and temporally related to the incident. The severity of exposure tends to correlate with the likelihood of injury.[1] However, it should be noted that a seemingly low severity of exposure can lead to significant disease, and patients with mild exposure must also be evaluated thoroughly.[3]
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