What is included in the physical exam to evaluate smoke inhalation injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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In the primary survey, assess patency of the airway, breathing, and circulation. Maintain cervical immobilization in any patient who is obtunded, has distracting injuries, has been involved in a significant mechanism of injury, has bony tenderness, or complains of neck symptoms.

Assess breathing by respiratory rate, chest wall motion, and auscultation of air movement. Assess circulation by level of consciousness, pulse rate, blood pressure, capillary refill, and by symmetry and strength of pulses.

Perform a brief neurological evaluation, including a determination of the Glasgow Coma Scale, pupil size and reactivity, and any focal findings. Remove all clothing to expose traumatic injuries/burns and to prevent ongoing thermal injury from smoldering clothes. Evaluate patient's back and perform a log roll if appropriate.

Identification of signs or symptoms of airway compromise is important to permit early and aggressive treatment before rapid progression to upper airway obstruction and respiratory failure ensues.

The secondary survey continues in a complete head-to-toe examination as in any other trauma evaluation. Burns on the face, soot marks, and singed eyebrows or facial hair are indicative of smoke inhalation. Large cutaneous burns indicate an inability to escape flame and a risk for smoke inhalation injury. However, inhalation injury can occur without evidence of burns.

Recognizing that upper airway swelling may take several hours to develop is imperative. Thus, facial burns, hoarseness, stridor, upper airway injury with mucosal lesions identified upon oral examination or bronchoscopy, and carbonaceous sputum are indications to promptly secure artificial airway access.

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