Smoke inhalation

Epidemiology:

• Nearly 1.3 million fires were reported in the U.S. in 2019, resulting in 3,704 deaths and around 17,000 injuries.
• Residential fires, often cooking-related, caused the highest number of deaths compared to vehicle and outdoor fires.
• Men have higher fire-related death and injury rates than women, with African American and American Indian men having the highest rates.
• People over 85 have the highest death rate from smoke inhalation, while those aged 50-54 have the highest injury rate.
• In 2019, the U.S. national fire death rate was 10.7 per million population, and the injury rate was 50.6 per million population.

Signs and Symptoms:

• Symptoms of smoke inhalation injury include cough, wheezing, confusion, low oxygen saturation, burns, and hoarse voice.
• Complications can range from minor to major, including Acute Respiratory Distress Syndrome (ARDS) and upper airway swelling.
• Other complications may include pneumonia, vocal cord damage, and tracheal stenosis.
• Smoke inhalation injury is the most common cause of death in fire victims.

Mechanism:

• Inhalation of chemical toxins can damage upper and lower respiratory tract tissues.
• Damage to lower airways can lead to increased secretions, air sac collapse, and pulmonary edema.
• Thermal damage from hot fumes typically affects the upper respiratory tract, causing tissue sloughing and swelling.
• Systemic toxicity can occur from inhaling chemical compounds in fires, with carbon monoxide poisoning being common.
• Carbon monoxide blocks oxygen from binding to hemoglobin, leading to hypoxia and potential organ failure.

Treatment:

• First responders remove victims from fire, provide high-flow oxygen, assess consciousness, and check for burns.
• Intubation should be considered early for upper airway swelling due to heat exposure.
• Supportive measures for lower respiratory tract injury may include intubation, ventilator support, and airway suctioning.
• Intravenous fluids are debated in cases of burns and smoke inhalation injury due to potential pulmonary edema risks.
• Various treatments like nebulized bronchodilators and corticosteroids have differing perspectives on their utility.

Prevention:

• Install smoke alarms in homes and test them regularly.
• Have fire extinguishers and know how to use them.
• Create and practice a fire escape plan with all household members.
• Keep flammable materials away from heat sources.
• Properly maintain heating systems and appliances to prevent fires.

Smoke inhalation Data Sources