Inhalation injuries

Thermal injury

In thermal inhalation, the airway is injured by the introduction of superheated air or steam. Such injuries almost always occur in an enclosed environment, although occasional mishaps occur in association with wildland fires (see page 345). Because water conducts heat approximately 30 times as efficiently as air, the risk of injury is far greater with steam than with dry superheated air.

The heat injures the inside of the mouth and nose, throat, vocal cords, trachea, bronchi, and occasionally lungs. External signs of an inhalation injury include burns of the face and mouth, singed nasal hairs, soot in the mouth and nose, and/or a swollen uvula. Symptoms include shortness of breath; wheezing; coughing (particularly of carbonaceous black sputum); raspy, coarse breathing (stridor) noted most often during inspiration, with a barking quality that seems to originate in the neck; muffled voice; drooling; difficulty swallowing; swollen tongue; and agitation.

Once the burn injury has occurred, there is no effective way to limit its progress, so the victim should be transported as rapidly as possible to an emergency facility. If oxygen (see page 431) is available, it should be administered. If the victim’s condition deteriorates rapidly because the airway becomes swollen and obstructed, the only hope for survival is the placement of a tube directly through the vocal cords and into the trachea (endotracheal intubation), or the creation of an air passage through the neck (tracheotomy).