• Farhat Mushtaq and Colin A Graham.
• Department of Accident and Emergency Medicine, Crosshouse Hospital, Kilmarnock KA2 0BE, Scotland, UK.
• Eur J Emerg Med. 2004 Jun 1;11(3):141-4.

ObjectivesSmoke inhalation has become the principal cause of death in burns patients. There are few guidelines for the management of smoke inhalation in the accident and emergency department. The aim was to identify what factors influence immediate management.MethodsA retrospective case note review using data from three west of Scotland accident and emergency departments in 1999. Computerized record systems were used to identify suitable patients.ResultsOf 120 patients, 63 patients had incomplete data and were excluded. A total of 57 patients were classified into one of five categories: no burns, normal vital signs and examination (group 1, n=23); no burns, abnormal vital signs or examination (group 2, n=26); minor burns (<15% total body surface area) with or without abnormal vital signs or examination (group 3, n=5); major burns (>15% total body surface area) (group 4, n=2); in cardiac arrest on arrival (group 5, n=1). In groups 1 and 3, the result of two investigations significantly influenced management. In group 2, arterial blood gases and carboxyhaemoglobin levels were abnormal in 25% of cases, but only on one occasion did it influence an admission decision.ConclusionArterial blood gases, chest radiography and carboxyhaemoglobin estimation rarely influence immediate management. Patients presenting with normal vital signs and examination and short smoke exposure may be safe to discharge from the accident and emergency department without further investigation.

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