Differentials
Asthma
SIGNS / SYMPTOMS
History of long-standing episodes of cough, wheezing, and/or dyspnea.
Absence of obvious inhalation exposure.
May coexist with inhalation injury.
INVESTIGATIONS
Airflow obstruction documented prior to inhalation exposure.
COPD
SIGNS / SYMPTOMS
History of chronic cough, sputum production, and/or dyspnea.
Absence of obvious inhalation exposure.
Evidence of chronic pulmonary disease (barrel chest, clubbing).
May coexist with inhalation injury.
INVESTIGATIONS
Chest x-ray demonstrates lung hyperinflation and flattened diaphragm.
Pulmonary function testing reveals large lung volumes (total lung capacity, functional reserve capacity).
Cardiogenic edema
SIGNS / SYMPTOMS
History of congestive heart failure (CHF), or new-onset chest pain or palpitations.
Exam shows nonpulmonary evidence of CHF (elevated jugular venous pressure, extremity edema, ascites).
May coexist with inhalation injury.
INVESTIGATIONS
ECG, cardiac enzymes, or echocardiography suggestive of ischemia or heart failure.
Head trauma
SIGNS / SYMPTOMS
History of witnessed trauma or fall.
Exam demonstrates soft tissue injury, focal deficit on neurologic exam.
May coexist with inhalation injury.
INVESTIGATIONS
Head CT scan: may show signs of head trauma.
Carboxyhemoglobin (CO-Hb) level: normal if no coexistent inhalation injury.
Intoxication
SIGNS / SYMPTOMS
History of intoxicant use.
Constellation of symptoms suggestive of specific intoxication.
May coexist with inhalation injury.
INVESTIGATIONS
Urine toxicology screen: positive for drug use.
Serum ethanol level: positive for ethanol use.
Osmolar gap: increased in alcohol intoxication.
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