Signs of Inhalation Injury
Look for singed nasal hair, facial burns, soot in the mouth or sputum, hoarseness, stridor, and carbonaceous sputum. A history of being in an enclosed space during a fire raises suspicion. Swelling can progress rapidly, closing the airway within minutes to hours.
Carbon Monoxide and Cyanide
Carbon monoxide binds hemoglobin more strongly than oxygen, and pulse oximetry can read falsely normal. Treat suspected exposure with high-flow oxygen by non-rebreather mask. Cyanide poisoning from burning plastics should be considered in patients with altered mental status and unexplained shock.
Airway Management
Early intubation by a qualified provider may be necessary before edema makes it impossible. Be prepared with a smaller tube size and a surgical airway backup. Monitor oxygen saturation, work of breathing, and mental status continuously during transport.