Fires produce a variety of particles and toxic fumes that can damage eyes and respiratory systems and aggravate other medical conditions. Inhalation injuries occur in nearly one-third of all major burns and are a significant cause of death among burn victims. These injuries can take the form of smoke inhalation or burns to the inside of the throat.
Smoke inhalation is the single most influential factor when evaluating the length of hospitalization and mortality rates of burn victims. It is associated with a 230% increase in the length of hospitalization and 400% increase in mortality.
Smoke inhalation is so dangerous because of its potential to limit the body’s access to oxygen and/or prevent oxygen from entering the bloodstream. Brain cells begin to die rapidly without oxygen, and the probability of recovering diminishes rapidly as the time without oxygen increases. Smoke inhalation prevents the body from obtaining sufficient oxygen through simple asphyxiants, irritant compounds, or chemical asphyxiants.
Smoke is composed of a variety of fine soot particles and gases that replace oxygen in the air. Fires use up oxygen as they burn, and the oxygen is replaced by gases such as carbon dioxide. Carbon dioxide is an invisible, tasteless, and odorless gas which is denser than oxygen. It displaces oxygen in the air making breathing difficult and less efficient. If a sufficient amount of oxygen is displaced by carbon dioxide, or other similar gases, it can lead to suffocation.
The fine soot particles in smoke also cause trouble. The throat is made up of sensitive mucus membranes. When the soot in smoke is breathed in, it begins to irritate these membranes and disrupt the normal lining of the respiratory system. The disruption can lead to swelling, airway collapse, and respiratory distress.
Finally, smoke also contains chemical compounds that interfere with the body’s ability to process oxygen. Carbon monoxide is an example of a chemical compound that is commonly found in smoke. Normally, oxygen loosely binds to the iron in blood and is released throughout the body by areas that have a stronger pull on oxygen than does the iron in the blood. Carbon monoxide disrupts this process because it forms very strong bindings with the iron in blood. Breathing enough carbon monoxide leaves no room for oxygen molecules to bond and thus the body is starved of oxygen. Carbon monoxide poisoning is one of the leading causes of death in smoke inhalation victims.
If a burn victim has been exposed to smoke and exhibits any of the symptoms listed below, seek immediate medical treatment.
- Prolonged coughing
- Difficulty breathing
- Facial burns
Minor amounts of smoke inhalation—such as breathing in smoke around a camp fire—do not typically require any treatment. Moving away from the smoke and breathing fresh air is usually enough for the body to recover. More serious amounts of smoke inhalation or smoke inhalation accompanying other types of burns require medical attention.
Medical treatment focuses primarily on reestablishing the body’s airways and getting oxygen levels back to normal. The simplest method is to increase the supply of oxygen to the victim through an oxygen mask or tube. In cases where the airways are blocked, medical staff may intubate by placing a tube down the throat to keep the airway open and prevent closure due to swelling. More severe treatment calls for bronchodilators or a bronchoscopy. Bronchodilators are medications that open up the bronchi and bronchioles—the passageways between the throat and the lungs. Bronchoscopy is a procedure that is used to suction debris or excess mucus that builds up in the throat and blocks the airways.
Smoke can make you disoriented or knock you unconscious, so it is safest to avoid breathing smoke as much as possible. Smoke fills confined spaces from top to bottom due to its heat. While it may be tempting to move as quickly as possible to escape a fire, getting low to the floor—crouching or even crawling on your hand and knees—is the safest way to avoid breathing in smoke. Placing a cloth loosely over your face can help filter out some of the harmful effects. If possible, wetting the cloth will provide additional protection, but the protection is only partially effective. Move away from the source of the smoke as soon as possible and contact the appropriate emergency agency.
The internal tissue of the throat is extremely sensitive to heat and can be burned by inhaling smoke, steam, or toxic fumes. Burns to the throat can be classified based upon the source causing the burn.
Intense flames can superheat the surrounding air. When that air is breathed it can burn the sensitive tissue inside the throat. The hot particles of soot inside smoke can also cause burns to the throat when breathed in. Finally, hot liquids or steam can scald the throat. These types of thermal burns are extremely painful and pose a serious health risk because they may lead to swelling. Swelling in the throat can close off airways and prevent the body’s ability to process oxygen.
As mentioned on the chemical burn page, chemical burns can be the result of fumes as well as direct contact with the chemical. Fumes are particularly dangerous because of the potential that a victim will unknowingly breathe them in. Chemical burns over a period of time may lead to acute inhalation injury. This is especially common in professions such as cleaning that deal with harmful chemicals on a regular basis.
Victims of chemical burns inside the throat may experience symptoms including minor respiratory discomfort, inflammation, fluid in the lungs, and shedding of the throat tissue which can lead to internal scarring. Left untreated these conditions can lead to death.