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5.05 Inhalation Injury


The patient was trapped in an enclosed space for some time with toxic gas or fumes produced by a fire, leak, evaporation of solvent, chemical reaction, fermentation of silage, etc., and comes to the ED complaining of some combination of coughing, wheezing, shortness of breath, irritation or running of eyes or nose, chest or abdominal pain, or skin irritation. More severe symptoms include confusion and narcosis. Symptoms may develop immediately or after a lag of as much as a day. On physical examination, the victim may smell of the agent or be covered with soot or burns. Inflammation of the eyes, nose, mouth, or uppe rairway may be visible, while pulmonary irritation may be evident as coughing, ronchi, rales, or wheezing, although these signs may also take up to a day to develop.

What to do:

What not to do:


One category of inhalation injury is caused by relatively inert gases, such as carbon dioxide and fuel gases (methane, ethane, propane, acetylene) which displace air and oxygen,producing asphyxia. Treatment consists of removing the victim from the gas and allowing him to breathe air or oxygen, and attending to any damage caused by the period of hypoxia (myocardial infarction, cerebral injury).

A second category of inhalation injury is from irritant gases: ammonia (NH3), formaldehyde(HCHO), chloramine (NH2Cl), chlorine (Cl2), nitrogen dioxide (NO2) and phosgene (COCl2), which, when dissolved in the water lining the respiratory mucosa, produce a chemical burn and an inflammatory response. The first gases listed, being more soluble in water, tend to produce more upper airway burns, irritating eyes, nose, and mouth, while the latter gases, being less water soluble, produce more pulmonary injury and respiratory distress.

A third category of inhalation injury includes gases which are systemic toxins, such as carbon monoxide (CO), hydrogen cyanide (HCN), and hydrogen sulfide (H2S), all of which interfere with the delivery of oxygen for cellular energy production, and aromatic and halogenated hydrocarbons, which can produce later liver, kidney, brain lung, and other organ damage

A final category of inhalation injury is allergic, in which inhaled gases, particles or aerosols produce bronchospasm and edema much like asthma or spasmodic croup.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD