## Assessment of Inhalation Injury **Key Point:** Inhalation injury cannot be excluded based on the absence of early clinical signs. Laryngeal edema, pulmonary edema, and airway obstruction may develop over hours to days after thermal or chemical injury to the respiratory tract. **High-Yield:** The presence of singed nasal hairs or carbonaceous sputum increases suspicion for inhalation injury, but their absence does NOT rule it out. Inhalation injury is confirmed by: - Bronchoscopy (gold standard) - Carboxyhemoglobin levels (for carbon monoxide poisoning) - Progressive respiratory distress and hypoxemia - Chest imaging changes (may be delayed) ## Why the Other Options Are Correct | Concept | Validity | |---------|----------| | **Parkland Formula** | $Fluid (mL) = 4 \times TBSA(\%) \times Weight(kg)$; half given in first 8 hours, remainder over next 16 hours. This is the standard for initial resuscitation in moderate-to-severe burns. | | **Circumferential Escharotomy** | Circumferential full-thickness burns restrict chest wall compliance and can cause "circumferential burn syndrome." Escharotomy is indicated if there is respiratory compromise or rising airway pressures. | | **Burn Depth Assessment** | Clinical assessment of burn depth is most accurate within 24–48 hours. Early assessment may be unreliable due to edema and inflammation. | **Clinical Pearl:** Inhalation injury is present in ~20–30% of hospitalized burn patients and significantly increases mortality. A high index of suspicion and early bronchoscopy are warranted in any patient with burns in an enclosed space, altered mental status, or respiratory symptoms — regardless of initial clinical appearance. [cite:ATLS 10e Ch 7]
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