Gas exchange can be compromised for a number of reasons:

  • Direct damage from inhalation injury to lower airways and gas exchange surfaces
  • Carbon monoxide (CO) can quickly build up impairing oxygen carrying capacity 9,10.
  • Burnt tissues with significant loss of the elasticity in superficial fibres are known as an eschar. This creates a constricting effect and inhibits expansion (figure 11). When circumferential around the chest/torso/neck this can lead to impaired chest expansion and subsequent ventilation issues9,10,11
Figure 11


  • Exposure of the chest to assess for any injuries, and adequacy of ventilation
  • Prompt assessment of oxygenation with a saturation probe9,10,11
  • Baseline blood gas (to assess oxygenation, ventilation, and carbon monoxide9,10,11


  • Initially high flow oxygen (bear in mind that peripheral saturation readings may be falsely elevated with raised carbon monoxide levels), which can be later titrated to target appropriate saturations9,10
  • Immediate discussion with burns centre if any restriction of movement of chest9,10
  • Suspected inhalation injury may warrant intubation9,10

Common pitfalls:

  • Failure to recognise rising CO level
  • Failure to recognise poor ventilation and the need for escharotomy

Top Tips:

  • Escharotomy can be a lifesaving procedure that relieves restriction of movement and allows chest expansion. This is an emergency situation this will be discussed later
  • Cyanide poisoning is common in patients that have been exposed to inhalation of burnt household items. In profound hypoxia consider early administration of cyanokit .10