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For further information, see CMDT Part 9-29: Smoke Inhalation
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Among patients treated for burn injuries, 33% also have pulmonary injury from smoke inhalation
Inhalation injury occurs as a result of impaired oxygenation, thermal injury to the upper airway, and lung injury to the lower airways and lung parenchyma
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Bronchorrhea and bronchospasm are seen early after exposure along with dyspnea, tachypnea, and tachycardia
Labored breathing and cyanosis may follow
Diffuse wheezing and rhonchi
Acute respiratory distress syndrome (ARDS) may develop 1–2 days after exposure
Sloughing of the airway mucosa may occur in 2–3 days, leading to airway obstruction, atelectasis, and worsening hypoxemia
Bacterial colonization and pneumonia are common 5–7 days after exposure
Complications become evident by 18–24 hours and include
Mucosal edema, upper airway obstruction, and impaired ability to clear secretions, all of which produce inspiratory stridor
Respiratory failure in severe cases
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Arterial blood gases (ABGs) are necessary to evaluate oxygenation and rule out carbon monoxide poisoning
Examination of the upper airway with a laryngoscope or bronchoscope is superior to physical examination
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Supplemental oxygen, humidified air, bronchodilators, and suctioning of mucosal debris and secretions, elevation of the head to 30 degrees, topical epinephrine
Endotracheal intubation often necessary to establish airway patency and likely needed with deep facial burns or oropharyngeal or laryngeal edema; tracheostomy should be avoided
Positive end-expiratory pressure has been advocated when there is pulmonary edema
Fluid management and close monitoring for secondary bacterial infection
Helium-oxygen (Heliox) helpful if labored breathing
Corticosteroids may be harmful
Monitoring for bacterial infection is important, but prophylactic antibiotics are not recommended
Close monitoring with ABGs and oximetry