Burns and soft-tissue emergencies

Inhalational, electrical and chemical burns

Overview and approach

These mechanisms can cause serious internal injury disproportionate to skin findings.

  • Special burns from your objectives: respiratory (inhalation), electrical and chemical (1)(2)(3).
Assessment and clinical features

Smoke/enclosed space, voice/airway symptoms, exposure agent, electrical path and loss of consciousness.

  • Inhalation: suspect with soot, singed hairs, hoarseness, stridor, carbonaceous sputum, facial or neck burns, enclosed-space exposure (1)(2)(3).
  • Electrical: voltage, duration, entry and exit wounds, loss of consciousness, arrhythmia, muscle injury (1)(4).
  • Chemical: agent (acid, alkali, hydrofluoric acid), concentration, duration, eye involvement.
Differentials and investigations

Monitored airway assessment, selected CO/toxicology/electrical-injury testing; involve poison/burns services.

  • Inhalation: carboxyhaemoglobin and lactate; cyanide toxicity in enclosed-space fires; bronchoscopy as directed by senior staff.
  • High-voltage or significant electrical injury: 12-lead ECG, cardiac monitoring, CK and urine myoglobin (1)(4).
  • Hydrofluoric acid: ECG and calcium, magnesium and potassium monitoring (QT prolongation) (5).
Management and follow-up

Resuscitation and mechanism-specific decontamination/treatment; avoid exposing staff and use appropriate protection.

  • Inhalation: 100% oxygen, early intubation for distress or progressive airway oedema (1)(2)(3).
  • Electrical: make safe first; cardiac monitoring; fluids for rhabdomyolysis; assess compartments (see Acute compartment syndrome).
  • Chemical: remove clothing and irrigate copiously with water (hydrofluoric acid: at least 30 minutes, then calcium gluconate gel) (1)(5). Contact Poisons Information (13 11 26 in Australia) and follow local protocols.
  • All require burns-service discussion.
Red flags and clinical pearls

Airway deterioration, arrhythmia and toxic exposure need early expert help. Normal pulse oximetry does not exclude carbon monoxide poisoning.

  • Airway oedema can progress rapidly: intubate early rather than late.
  • Small entry wounds can hide deep muscle injury.
References
  1. NSW ACI ECAT: Adult burns
  2. Vanderbilt: Adult inhalation injury protocol (2026)
  3. RCH: Burns - acute management
  4. IAEM: Management of thermal, chemical and electrical burns in the ED
  5. StatPearls: Hydrofluoric acid burns

Last updated from Sen’s notes on 9 October 2026.