About Inhalation Injuries

More than a hundred known toxic substances are present in fire smoke. When inhalation injuries are combined with external burns the chance of death can increase significantly. According to the National Fire Protection Association in 1997, 4,675 firefighters suffered burn injuries as a result of performing their assigned duties, of which 3,770 also suffered inhalation injuries.

Because of the damage that can be caused by inhaling smoke, steam or noxious gas, it's important that rescue workers remove patients as soon as possible from the harmful area and allow them to breath fresh air or receive oxygen therapy.

Types of Injuries

Fire can cause three different types of inhalation injuries:

1. Damage from Heat Inhalation
   True lung burn occurs only by directly breathing in a hot air or the flame source, or by having high pressure force the heat into you. In most cases, thermal injury is confined to the upper airways, because the trachea usually shields the lung from thermal loads. However, secondary airway involvement can occur if steam is inhaled, because steam can hold more heat than dry air. When hot air enters the nose, it can cause damage to the mucous membranes, because the nose, mouth and throat act as a cooling chamber.
2. Damage from Inhaled Toxins
   Systemic toxins affect our ability to absorb oxygen. If someone is found unconscious or acting confused in the surroundings of an enclosed fire, systemic toxins could be a possible cause. Toxin poisoning can cause permanent damage to organs, including the brain. In some cases, as with carbon monoxide, poisoning can appear symptomless up until the point where the victim falls into a coma.
3. Damage from Smoke Inhalation
   Smoke intoxication is frequently hidden by more visible injuries such as burns as a result of fire. In a disaster situation, this can lead to not receiving proper medical attention because rescue teams may take care of patients that seem to need more help first. Patients who appear as though they are unharmed can collapse due to major smoke inhalation. In fact, 60% to 80% of fatalities resulting from burn injuries can be attributed to smoke inhalation.

Symptoms and Treatment

Symptoms of inhalation injury usually appear within 2 to 48 hours after the burn has occurred. Symptoms can include:

• Fainting
• Difficulty breathing
• Soot around the mouth or nose
• Singed nasal hairs, eyebrows or eyelashes
• Burns around the face or neck

Swelling of the upper airway is the earliest consequence of inhalation injury. This usually occurs the first 6 to 24 hours after injury. Patients who have difficulty breathing are intubated and monitored closely.