Smoke inhalation

Deaths from smoke inhalation remain depressingly frequent and most often occur because the victim cannot escape the toxic effects of carbon monoxide. Delayed sequelae of smoke inhalation greatly increase the mortality from cutaneous burns. This article outlines the supportive care of smoke casualties and discusses some of the dilemmas in management which result from the absence of specific therapies.

[Smoke poisoning. Inhalation injuries from remaining at the scene of a fire]

In 1987, 87 persons died in Denmark as the result of fires. Fifteen of these occurred after arson. The commonest immediate cause of death in connection with fire is smoke inhalation. The pathophysiology of smoke inhalation is reviewed. The injurious effects on health may be subdivided into three different groups, viz thermal injuries to the respiratory passages, hypoxia and carbon monoxide poisoning and the toxic effects on the pulmonary parenchyma of various compounds (particles, gases and steam) which develop from the burning materials in the process of burning. After this, the symptomatology and treatment of smoke inhalation are reviewed. Treatment is primarily supportive and symptomatic. Finally, the various fire-extinguishing agents employed to extinguish fires at present are reviewed. Some of these have potentially injurious effects.

Smoke inhalation injury in sheep

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Inhalation injuries

Inhalation injuries occur in approximately one-third of all major burns and account for a significant number of deaths in those burn patients each year. Victims die as a result of carbon monoxide poisoning, hypoxia, and smoke inhalation. These deaths can occur without thermal wounds as well as with burn injuries. There are three distinct problems with inhalation injuries: thermal burns of the upper airway, carbon monoxide poisoning, and smoke inhalation. Each has different symptoms and signs, different treatment, and different prognosis. Thermal burns occurring in the upper airway are usually manifested within 48 hours of injury. Diagnosis is made by direct visualization of the upper airway, looking for signs of thermal injury. Admission for observation with humidified oxygen, attentive pulmonary toilet, bronchodilators as needed, and prophylactic endotracheal intubation as indicated are the mainstays of treatment. Resolution of the injury usually occurs within days. Carbon monoxide poisoning, the most common cause of death in inhalation injury, is a result of combustion. Symptoms and signs correlate with blood levels, but arterial blood gases are used to determine the degree of carbon monoxide intoxication. Treatment is based on the principle that carbon monoxide dissociation occurs much faster if the patient is placed on 100% oxygen. Occasionally the patient's symptoms may persist or get worse despite adequate treatment. Smoke inhalation significantly damages normal respiratory physiology, resulting in injury progressing from acute pulmonary insufficiency to pulmonary edema to bronchopneumonia, depending on the severity of exposure. Diagnosis is based on history, but clinical findings, arterial blood gases, and fiberoptic bronchoscopy are helpful. Treatment is supportive with careful attention paid to fluid resuscitation in the patient with burns.(ABSTRACT TRUNCATED AT 250 WORDS)

Smoke inhalation

An attempt has been made to review the characteristics of fire and smoke and the epidemiology of smoke inhalation to identify some of the many variables which interact to control the severity of the injury. An experimental model appropriate to study the pulmonary injury of smoke victims who survive to enter the health care system is described. Experiments which define how smoke damages the lung are reviewed in an effort to explain why the smoke-damaged lung is vulnerable to additional stress and why those with an injured lung and a burn have such a high mortality rate.

Induction of bronchial hyperresponsiveness following smoke inhalation injury

We report two subjects without previous evidence of asthma in whom wheeze, breathlessness and bronchial hyperresponsiveness occurred following an acute smoke inhalation injury.

Acquired progressive asthma in a fire-fighter

A fire-fighter, who developed chronic severe asthma after exposure to decomposition products of plastics during routine fire-fighting, is described. The outcome was fatal 25 months after onset of the disease.