More severe symptoms include confusion and narcosis. Symptoms may develop immediately or after a lag of as much as a day. On physical examination, the victim may smell of the agent or be covered with soot or burns. Inflammation of the eyes, nose, mouth, or uppe rairway may be visible, while pulmonary irritation may be evident as coughing, ronchi, rales, or wheezing, although these signs may also take up to a day to develop. Make sure the victim is breathing adequately, and then add oxygen at 6 to 12 liters per minute.
Oxygen helps most inhalation injuries, and is essential in treating carbon monoxide poisoning.
Determine if there are significant pre-existing conditions such as cardiac or cerebral vascular disease, chronic obstructive pulmonary disease, asthma, or other chronic illness. If the patient has difficulty breathing or any x ray or blood gas abnormality suggesting acute pulmonary injury, he should be kept on oxygen and admitted to the hospital, even if only overnight. Wheezing and bronchospasm may be allergic reactions and respond to conventional doses of aerosolized bronchodilators, but, if not promptly reversible, are probably a sign of pulmonary injury. Repeat the patient's vital signs and physical exam, and consider repeating ABGs, and CXR in 12 to 24 hours, looking for any changes indicative of late pulmonary injury. Some agents produce pulmonary inflammation which develops over 12 to 24 hours.