When is hospitalization indicated for the treatment of smoke inhalation injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Patients with smoke inhalation should be monitored for 4-6 hours in the ED. Those who are at low risk for injury and whose vital signs and physical examination findings remain normal can usually be discharged with close follow-up and instructions to return if symptoms develop.

While there are no definite criteria for admission, patients with any of the following should be strongly considered for hospitalization:

  • History of closed-space exposure for longer than 10 minutes

  • History of syncope

  • Carbonaceous sputum production

  • Arterial PO2 less than 60 mm Hg

  • Metabolic acidosis

  • Carboxyhemoglobin levels above 15%

  • Arteriovenous oxygen difference (on 100% oxygen) greater than 100 mm Hg

  • Bronchospasm

  • Odynophagia

  • Central facial burns

For patients with isolated smoke inhalation, treatment in an intensive care unit is appropriate. However, patients with significant cutaneous burns should be transferred to a burn center when stable, if they meet the criteria for transfer.


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