List three early signs of inhalation injury that warrant early airway protection.

• A. Hoarseness/voice change, facial burns with soot or carbonaceous secretions, singed nasal hairs
• B. Cough with clear sputum and no facial burns
• C. Hoarseness only with no facial burns
• D. Stridor that only appears after several hours

Answer: (A)

Early signs of inhalation injury that signal a risk to the airway come from upper airway involvement due to smoke and heat. Hoarseness or a change in voice indicates edema of the larynx and vocal cords, which can swell quickly and close the airway. Facial burns accompanied by soot or carbonaceous secretions show that smoke has affected the face and upper airway, raising the chance of swelling, mucosal injury, and obstruction. Singed nasal hairs are a practical clue that heat exposure reached the nose and upper airway, again pointing to potential airway edema.

Because these signs reflect active injury to the upper airway, they justify protecting the airway early, often with preemptive intubation before edema progresses to a life-threatening obstruction. In contrast, a cough with clear sputum and no facial burns is less specific for imminent airway compromise, and hoarseness alone without other signs is less reliable for urgent airway protection. Stridor that only appears after several hours is a later warning sign; by then airway swelling may already be significant, making proactive protection the better approach.