Which physical findings suggest neurologic injury following smoke inhalation?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Signs of neurologic injury may take longer to appear than evidence of respiratory injury. Neurologic injury may result from hypoxia at the time of injury or hypoxia secondary to pulmonary dysfunction. Fear, severe pain, and obtundation from inadequate perfusion may cloud the neurologic examination. Serial examinations assessing the sensorium are extremely helpful in guiding the initial resuscitation and stabilization.

Patients exposed to asphyxiants, including CO and cyanide (CN), present with hypoxic injury and subsequent CNS depression, lethargy, and obtundation. Hypoxia is caused by an asphyxiant and is usually evident upon presentation. Irritability, severe temporal headache, and generalized muscle weakness are also common findings.

Coma following exposure to fire is nearly always indicative of CO poisoning and should be promptly treated with 100% oxygen. Suspect CN toxicity in the patient whose sensorium remains clouded and who does not respond to oxygen therapy.

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