The number one cause of death related to fires is smoke inhalation. An estimated 50-80% of fire deaths are the result of smoke inhalation injuries rather than burns. Smoke inhalation occurs when you breathe in the products of combustion during a fire. Combustion results from the rapid breakdown of a substance by heat (more commonly called burning). Smoke is a mixture of heated particles and gases. It is impossible to predict the exact composition of smoke produced by a fire. The products being burned, the temperature of the fire, and the amount of oxygen available to the fire all make a difference in the type of smoke produced.
Smoke inhalation damages the body by simple asphyxiation (lack of oxygen), chemical irritation, chemical asphyxiation, or a combination of these.
- Simple asphyxiants
- Combustion can simply use up the oxygen near the fire and lead to death when there is no oxygen for a person to breathe.
- Smoke itself can contain products that do not cause direct harm to a person, but they take up the space that is needed for oxygen. Carbon dioxide acts in this way.
- Irritant compounds
- Combustion can result in the formation of chemicals that cause direct injury when they contact the skin and mucous membranes.
- These substances disrupt the normal lining of the respiratory tract. This disruption can potentially cause swelling, airway collapse, and respiratory distress.
- Examples of chemical irritants found in smoke include sulfur dioxide, ammonia, hydrogen chloride, and chlorine.
- Chemical asphyxiants
- A fire can produce compounds that do damage by interfering with the body’s oxygen use at a cellular level.
- Carbon monoxide, hydrogen cyanide, and hydrogen sulfide are all examples of chemicals produced in fires that interfere with the use of oxygen by the cell during the production of energy.
- If either the delivery of oxygen or the use of oxygen is inhibited, cells will die.
- Carbon monoxide poisoning has been found to be the leading cause of death in smoke inhalation.
Smoke Inhalation Symptoms
Numerous signs and symptoms of smoke inhalation may develop. Symptoms may include cough, shortness of breath, hoarseness, headache, and acute mental status changes.
Signs such as soot in the airway passages or changes in skin color may be useful in determining the degree of injury.
- Cough
- When the mucous membranes of the respiratory tract get irritated, they secrete more mucus.
- Bronchospasm and increased mucus production lead to reflex coughing.
- The mucus may be either clear or black depending on the degree of burned particles deposited in the lungs and trachea.
- Shortness of breath
- This may be caused by direct injury to the respiratory tract, leading to decreased oxygen delivery to the blood, the decreased ability of blood to carry oxygen because of chemicals in smoke, or the inability of the body’s cells to use oxygen.
- The patient may have rapid breathing as they attempt to compensate for these injuries.
- Hoarseness or noisy breathing
- This may be a sign that fluids are collecting in the upper airway and may cause a blockage.
- Irritant chemicals may cause vocal cord spasm, swelling, and constriction of the upper airways.
- Eyes: Eyes may be red and irritated by the smoke, and there may be burns on the corneas in the eyes.
- Skin color: Skin color may range from pale to bluish to cherry red.
- Soot
- Soot in the nostrils or throat may give a clue as to the degree of smoke inhalation.
- The nostrils and nasal passages may be swollen.
- Headache
- In all fires, people are exposed to various quantities of carbon monoxide.
- The patient may have no respiratory problems, but may still have inhaled carbon monoxide.
- Headache, nausea, confusion and vomiting are symptoms of carbon monoxide poisoning.
- Changes in mental status
- Chemical asphyxiants and low levels of oxygen can lead to mental status changes.
- Confusion, fainting, seizures, and coma are all potential complications following smoke inhalation.
When To Seek Immediate Care.
If the smoke inhalation victim has no signs or symptoms, home observation may be appropriate. If in doubt, call the doctor or go to the local emergency department for advice.
Seek medical attention if the patient experiences the following symptoms with smoke inhalation:
- Hoarse voice
- Difficulty breathing
- Prolonged coughing spells
- Mental confusion
Decide whether to call an ambulance for assistance.
- Someone with smoke inhalation can get worse quickly.
- If such a person were transported by private vehicle, significant injury or death could occur on the way that could have been avoided if that person were transported by emergency medical services.
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