a. General Information.

More than half of all fire related deaths are caused by smoke inhalation.

Eighty percent of those who die in residential fires do so because they have inhaled heated air, smoke, or other toxic gases. The substance inhaled by the patient can burn the respiratory tract causing potentially lethal results.

b. Causes.

Three causes of inhalation injury are heat inhalation, inhalation of
toxic chemicals or smoke, and inhalation of carbon monoxide gas. A thermal burn patient who was in an enclosed space is liable to also have an inhalation injury.

c. Severity of Inhalation Burn.

These factors determine the severity of an inhalation burn:

(1) Products of combustion (what the products were).

(2) Degree of combustion (how complete the combustion was).

(3) Duration of exposure (how long the patient was exposed).

(4) Whether the person was in an enclosed space.

d. Effects on the Body.

The effects on the body of inhaled toxic substances include the following.

(1) Internal damage. When noxious fumes are inhaled, mucosa in the lungs swell and break. This results in fluid leaking into the nearby alveolar spaces and damaging the cilia. Mucus builds up and plugs the air passages. This may lead to reduced oxygen exchange and, if left untreated, death.

(2) Cause of death. The usual cause of death in inhalation cases is from pneumonia. An immediate death is often caused by respiratory edema; therefore, edema is the greater concern when you are caring for an inhalation patient.

(3) Carbon monoxide poisoning. Carbon monoxide poisoning is a major cause of death at the scene of a fire. Even when it is not the cause of death, it can cause long term neurological damage by depriving the brain of oxygen.

NOTE: Almost anything gives off carbon monoxide when it burns. It is colorless, odorless, and tasteless, making it difficult to detect.

(4) Unconscious patient. If an inhalation victim is unconscious, assume he is suffering from carbon monoxide poisoning.

(5) Conscious patient. Consider carbon monoxide poisoning if the patient shows the following signs and symptoms.

(a) Headache and weakness.

(b) Nausea and/or vomiting.

(c) Loss of manual dexterity.

(d) Acts confused, lethargic, irrational, or reckless.

(6) Very late signs of carbon monoxide poisoning. Included are cherry-red coloring of the unburned skin, changes in coloration of the mucous membranes, unconsciousness, and obvious neurological damage. Do not wait for these signs since cherry-red coloring may not occur until after death.

e. Signs and Symptoms of Carbon Monoxide Poisoning.

Suspect carbon monoxide poisoning if you observe the following:

(1) Edema of the face and neck.

(2) Singed nasal hairs.

(3) Carbonaceous sputum (caused by the death of lung tissue).

4) Burned mucosa in the mouth and throat (redness, swelling).

(5) Sooty smell to the breath.

(6) Dyspnea.

(7) Hoarseness.

(8) Stridor (a harsh, shrill respiratory sound), a medical emergency if present.

(9) Depressed mental activity.

f. Treatment of Inhalation Injury.

When treating inhalation injury patients, remember to assess the airway continually. Generally, follow these guidelines.

(1) Remove the patient from the area and place him in an area with fresh air.

(2) Clear the airway immediately.

(3) Administer humidified oxygen (100 percent) to minimize damage by the scorching heat.

(4) If the patient is alert and has adequate blood pressure, place him in an upright position. In this position, gravity helps reduce fluid retention in his tissues, and he can breathe easier.

(5) Mouth to mouth or mouth to mask ventilation may be required.

(6) If there is respiratory distress, insert an airway.

(7) Remove any clothing that may restrict his chest movement or breathing.

(8) Evacuate the patient to a medical treatment facility.