Smoke Inhalation Nursing Guide

What is smoke inhalation? 

Smoke inhalation occurs when a person breathes in harmful gases, particles, or chemical irritants released during a fire or combustion process. It’s a leading cause of morbidity and mortality in fire-related injuries. Smoke inhalation can cause thermal damage to the upper airways, chemical damage to the lungs, and systemic toxicity due to gases such as carbon monoxide (CO) and cyanide. 

Etiology and epidemiology 

Etiology 

• Exposure to fire or combustion materials, including smoke from burning wood, plastic, textiles, or chemicals
• Toxic gases (e.g., carbon monoxide, cyanide, ammonia)
• Particulate matter that causes physical damage to the airways 

Epidemiology 

• Annually, most deaths in fire incidents are attributed to smoke inhalation.
• Smoke inhalation is common in residential fires, industrial accidents, and vehicular accidents.
• Risk factors include being in enclosed spaces during a fire and pre-existing respiratory or cardiovascular conditions. 

  Smoke inhalation ICD-10 code 

T59.811A — Toxic effect of smoke, initial encounter 

Diagnosis 

Clinical presentation 

• Respiratory symptoms: Dyspnea, coughing, wheezing, stridor
• Systemic symptoms: Headache, dizziness, confusion, or altered mental status (suggesting carbon monoxide or cyanide poisoning)
• Visual findings: Soot in the oropharynx, singed nasal hairs, facial burns 

Diagnostic tests 

• Arterial blood gas (ABG): This evaluates oxygenation, ventilation, and acid-base status.
• Carboxyhemoglobin level: This indicates carbon monoxide poisoning.
• Cyanide levels: This assesses cyanide toxicity.
• Chest X-ray or CT scan: This identifies pulmonary damage like atelectasis or edema.
• Bronchoscopy: This visualizes airway injury. 

Management 

Emergency care 

• Airway protection: Intubation if airway compromise is evident or anticipated.
• Inhalation grading: Using this grading system classifies the degree of airway damage observed.
  • Grade 0: No injury — No carbonaceous deposits, erythema, edema, bronchorrhea, obstruction
  • Grade 1: Mild — Minor/patchy areas of carbonaceous deposits, erythema, edema, bronchorrhea, obstruction
  • Grade 2: Moderate — Moderate degree of carbonaceous deposits, erythema, edema, bronchorrhea, obstruction
  • Grade 3: Severe — Severe inflammation, friability, copious carbonaceous deposits, bronchorrhea, obstruction
  • Grade 4: Massive — Evidence of extensive mucosal sloughing tissue necrosis, endoluminal obstruction
• Oxygen therapy: 100% oxygen via a non-rebreather mask or endotracheal tube to displace carbon monoxide and improve oxygenation.
• Treatment of cyanide poisoning: Administer hydroxocobalamin or sodium thiosulfate. 

Additional measures 

• Bronchodilators can be used for bronchospasm.
• N-acetylcysteine can be added to nebulized heparin (to decrease cast formation) and albuterol. This should be initiated and continued for seven days post-inhalation injury.
• Intravenous fluids can maintain hemodynamic stability.
• Hyperbaric oxygen therapy can be used for severe cases of carbon monoxide poisoning.
• Pain management and wound care if burns are present. 

Nursing care plan 

Nursing considerations 

• Assess and maintain airway patency.
• Monitor oxygen saturation and ABG results regularly.
• Position the patient to optimize breathing (e.g., semi-Fowler’s position).
• Provide emotional support to reduce anxiety.
• Administer prescribed medications promptly. 

Assessment 

• Inspect the airway for burns, soot, or swelling.
• Monitor respiratory rate, effort, and lung sounds.
• Assess for signs of hypoxia or cyanosis. 

Nursing diagnosis/risk for 

• Ineffective airway clearance related to smoke inhalation
• Impaired gas exchange related to toxic gas exposure
• Risk for infection related to burns or airway injury
• Acute pain related to thermal and chemical injury 

Interventions 

• Administer 100% oxygen therapy as prescribed.
• Conduct frequent respiratory assessments to identify deterioration early.
• Assist with intubation or mechanical ventilation if needed.
• Educate the patient and caregivers about smoke inhalation risks and prevention strategies.
• Encourage coughing or suctioning to clear secretions, if appropriate. 

Expected outcomes 

• The patient maintains a clear and patent airway.
• Oxygen saturation levels remain within normal limits.
• Pulmonary function improves, and symptoms of respiratory distress resolve.
• The patient and caregivers demonstrate an understanding of prevention strategies. 

Individual/caregiver education 

• Teach the importance of installing and maintaining smoke detectors at home.
• Discuss strategies for safe evacuation during fires.
• Educate on the risks of smoke inhalation and the signs of respiratory distress to seek immediate medical care.
• Emphasize adherence to follow-up appointments and therapies. 

Resources 

• American Lung Association 
• National Fire Protection Association (NFPA) 
• Centers for Disease Control and Prevention (CDC) 
• PEPID — Burns: Inhalation Injuries 

References 

1. ICD10Data.com. (2025). Toxic effect of smoke, initial encounter (T59.811A). Retrieved from https://www.icd10data.com/ICD10CM/Codes/S00-T88/T51-T65/T59-/T59.811  
2. American Lung Association. (n.d.). Understanding smoke inhalation. Retrieved from https://www.lung.org/  
3. National Fire Protection Association. (n.d.). Fire and safety resources. Retired from https://www.nfpa.org/NFPA-Solutions