Smoke inhalation injury

(Redirected from Smoke inhalation)


  • Main cause of mortality in fire-related death
  • Associated with closed-space fires, especially when patient has decreased mental status (e.g. substance use, head injury)
  • Thermal injury:
    • Due to inhaling superheated gases in an enclosed space
    • Direct thermal trauma and associated edema usually limited to upper airway, but lower respiratory tract may be injured if steam inhaled
  • Chemical injury:
    • Direct toxicity to airways and lung parenchyma from noxious chemicals combusted

Clinical Features

Thermal injury

Chemical injury

Varies depending on substance burned in fire

Systemic chemical injury

Differential Diagnosis


Inhalation injury


Toxic gas exposure


  • Assess ABCs, burns resuscitation
  • ABG or VBG, carboxyhemoglobin
  • ECG, monitor on telemetry
  • Chest x-ray
  • Low threshold for direct or video laryngoscopy, fiberoptic airway eval



  • Intubate if:
    • Respiratory distress, respiratory depression, or altered mental status
    • Progressive hoarseness
    • Supraglottic or laryngeal edema/inflammation on bronchoscopy or NPL
    • Full thickness burns to face or perioral region
    • Circumferential neck burns
    • Major burns over 40-60% of body surface area

Remember, the intubation will only get more difficult as edema worsens!


  • Respiratory distress or airway compromise will need admission
  • Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop

See Also

External Links