EM Vivas · Burn management
Inhalation injury — assessment and management
A clinical viva on the inhalation injury.
On this page
Study tools
Target exams
ACEMFRCEMABEM
Prompt
Describe the three components of the inhalation injury, how each is identified in the emergency department, and the treatment for each.
Interpretation
Reveal interpretationShowHide
- Supraglottic thermal injury — hot gas burns the upper airway, producing oedema that can obstruct over hours. Identified by facial burns, singed nasal hairs, carbonaceous sputum, hoarseness, stridor. Managed by early intubation before the oedema closes the airway (Otterness: diagnosis mostly clinical; many patients worsen after admission).[2]
- Carbon monoxide poisoning — CO binds haemoglobin with affinity about 200 to 250 times that of oxygen (Bourke/StatPearls). Identified by COHb on co-oximetry; standard pulse oximetry cannot distinguish COHb from oxyhaemoglobin. Room-air half-life about 320 minutes; 100% oxygen reduces it to less than 90 minutes (Weaver: 74 ± 25 min at 1 atm). Primary treatment is supplemental oxygen, usually a non-rebreather (Chenoweth); HBO indications are controversial. StatPearls lists HBO candidates including COHb greater than 25% in adults or 15–20% in pregnancy, plus neurologic injury or loss of consciousness.[5][3][4]
- Cyanide poisoning — plastics and wool in enclosed fires. Identified by soot plus neurological impairment (Borron enrolment). Managed with hydroxocobalamin 5 g IV (maximum 15 g) in that series (72% of ICU admissions survived; 67% of confirmed-cyanide patients; no serious adverse events attributed). Jin 2025 SR: mortality similar to supportive care and possible AKI signal — use with caution, not as an automatic exam reflex.[6][1]
References6ShowHide
- [1]Jin WY, et al. Evidence for Hydroxocobalamin in Cyanide Toxicity Caused by Smoke Inhalation: An Updated Systematic Review. Emerg Med Int, 2025.PMID 41497958
- [2]Otterness K, et al. Emergency department management of smoke inhalation injury in adults. Emerg Med Pract, 2018.PMID 29489306
- [3]Chenoweth JA, et al. Carbon Monoxide Poisoning. Crit Care Clin, 2021.PMID 34053712
- [4]Weaver LK, et al. Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100% oxygen at atmospheric pressure. Chest, 2000.PMID 10713010
- [5]Bourke M, et al. Carbon Monoxide Poisoning. StatPearls, 2026.PMID 32491811
- [6]Borron SW, et al. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med, 2007.PMID 17481777