In this article, I’d like to discuss the effects of inhaling smoke caused by fires. Smoke inhalation involves the breathing in of toxic gases and particulate matter, causing emergency respiratory distress or even lung failure. Those trapped in contained areas, like buildings, are most likely to be affected.

You might wonder what smoke inhalation is doing in a series about burns. Well, smoke inhalation is essentially a burn in the upper airways and lungs; if the delivery of oxygen is inhibited, cells die. The result can be as life-threatening as skin burns caused by flames or scalds. Indeed, the majority of deaths in fires result from smoke inhalation.

CAUSES OF SMOKE INHALATION

Common causes of smoke inhalation include:

Simple Combustion: Combustion results from the destruction of a substance by heat (burning), producing smoke. Smoke consists of heated particles and gases, the composition of which depends on the item burning, the temperature of the fire, and other factors. Combustion uses up oxygen near a fire and can kill a person simply from oxygen deficit. The larger the fire, the more oxygen it removes from the area.

Carbon Dioxide: Some by-products of smoke may not directly kill a person, but could take up the space in the lungs that oxygen would ordinarily use. Even the expulsion of a large bubble of carbon dioxide from a wilderness lake can kill wildlife near it.

Chemical irritants: Many chemicals founds in smoke can cause irritation injury when they come in contact with the lung membrane. This amounts to a burn inside the lung tissue, which causes swelling and airway obstruction. Chlorine gas used in World War I is an example of a deadly chemical irritant.

Other asphyxiants: An “asphyxiant” is a gas that decreases the normal oxygen concentration in air. Carbon monoxide, cyanide, ammonia, and certain sulfides may interfere with the body’s ability to utilize oxygen. Of these, colorless and odorless carbon monoxide is the most common.

SMOKE INHALATION SYMPTOMS

Symptoms of smoke inhalation may include:

Cough: When the lining of your airways and lungs becomes irritated with thermal and other damage, the muscles that surround the passageways to lung tissue go into spasm and lead to reflex coughing. The lining of your respiratory tract also secretes more mucus than normal. It may appear clear, grayish, or even black depending on the amount of burned particles in your trachea, bronchi, and lungs.

Shortness of breath: Smoke inhalation decreases the supply of oxygen to your blood; breathing becomes more rapid to compensate for the deficit and take in the amount necessary to survive.

Hoarseness and noisy breathing: Toxic chemicals may irritate or damage vocal chords as they cause swelling and tightening of the upper airways. This results in hoarseness of varying severity. Mucus may become excessive and thicker, leading to partial blockages and loud breathing.

Eye Symptoms: Victims of smoke inhalation often have redness in their eyes. In severe cases, burns in the cornea may result.

Nose and throat issues: Smoke inhalation is sometimes diagnosed by the presence of soot in the nose and throat. Swelling can be noted in nostrils and the throat.

Chest pain: Besides simple irritation caused by reaction to smoke in the airways and excessive coughing, less oxygen flow to the heart can lead to chest pain in smoke inhalation victims.

Skin changes: Besides the effect of burns on the skin, carbon monoxide exposure may result in a bright pink or red coloration. If cyanosis is present, skin may appear a bluish color, especially around the lips and fingertips.

Altered mental status: Smoke inhalation often causes oxygen deficits in the brain. This leads to confusion, fainting, or other signs of altered mental status. Seizures and coma may also occur.

DIAGNOSIS AND TREATMENT OF SMOKE INHALATION

Besides the soot, hoarseness, shortness of breath, and other signs, diagnosis of smoke inhalation in austere settings involves evaluating the oxygen levels in the blood.

This can be done with a simple, compact device called a “pulse oximeter.” In oximetry, a small device is attached to the fingernail to determine the degree of oxygen in the person’s blood. Although not perfect, it’s a good general measure of oxygen saturation. Results below 92% saturation should alert you to an individual at risk.

To treat smoke inhalation, get the person out of the smoky area and into an environment where there is clean air. This may not be as easy as it seems. You must be very careful not to put yourself in a situation where you are likely to succumb to smoke inhalation yourself. If you have a face mask or other barrier to the smoke, use it.

Unfortunately, in survival settings, your options for treatment are limited. Be prepared to use CPR if necessary. It’s important to have some way to deliver oxygen to your patient if needed. There are cans or cylinders available which would be useful to get oxygen quickly into the lungs. Consider these for your medical storage, but realize they eventually run out of oxygen after a certain number of breaths, depending on the product. They also require lungs that are not so damaged that they can absorb that oxygen.

Don’t expect a rapid recovery from significant smoke inhalation. Your patient will be short of breath with the slightest activity and will be very hoarse. These symptoms may go away with time, or could become permanent disabilities if there is scarring in the respiratory treat.

PREVENTION

Have a plan in place to prevent smoke inhalation events in the first place. Planning escape routes and having regular drills will allow your people to get out of dangerous situations quickly. Pay attention while cooking in the kitchen or on a campfire. Avoid leaving space heaters unattended and dispose of smoking related items properly.

 If you have battery power, smoke and carbon monoxide detectors are useful. Escape plans should be worked out before a fire occurs.

Of course, if you’re caught in a fire, act as soon as you sense danger. Drop or crouch low to the ground; since smoke rises, the air closest to the floor is most breathable.

Wet a towel or item of clothing and hold it against your nose and mouth. The water may filter some of the poisonous gases, decreasing your exposure.

It’s preferable to get out of the building rather than locking yourself in a “safe room.” Few rooms are completely safe from smoke. Crawl out if you have to.

If you’re trapped inside a room with no hope of escape,  try to prevent as much smoke as possible from entering. Line the door frame and ducts with wet cloth or tape.

Staying situationally aware and knowing what to do will give you the best chance of avoiding smoke inhalation. Act quickly to get out of smoke-filled areas and a fire will be just a bump on the road, not the end of the road for you and your people.

Joe Alton MD

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