Smoke Inhalation

SMOKE INHALATION

DEFINITION

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Smoke inhalation is breathing in smoke. Smoke contains many substances that can cause damage to the human body.

DESCRIPTION

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The most common cause of smoke inhalation is fire in a structure, such as a home, office, or factory. People trapped in a burning structure as well as firefighters may inhale smoke produced by the fire.

Cigarette smoking also produces the effects of smoke inhalation. People who smoke do not get as much smoke into their lungs at once as someone trapped in a structural fire. Over a long period of time, however, the effects of cigarette smoking can add up. And eventually the effects on a person's lungs from smoking can be as bad or worse than those caused by other forms of smoke inhalation.

Smoke inhalation is responsible for a large number of the deaths caused by structural fires each year. In many cases, patients do not show symptoms of smoke inhalation until twenty-four to forty-eight hours after the fire. Because of this, they may not be diagnosed correctly and their medical problem may not be treated soon enough or by the correct methods.

CAUSES

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The smoke a person inhales can cause damage to the body in three different ways. First, the smoke may actually cause burns. The smoke is carried in by hot air that can damage or destroy tissues in the mouth, nose, and upper respiratory (breathing) system.

Smoke can also cause damage by irritating tissues. The materials found in smoke can be toxic (poisonous) to cells or they can cause physical damage by rubbing across tissues.

Finally, smoke can harm the body because it cuts off the supply of oxygen. Cells need oxygen in order to remain alive and function normally. If too much smoke is present in the body, it can prevent oxygen from reaching cells. Cells and tissues then begin to die from oxygen starvation.

Smoke Inhalation: Words to Know

Bronchodilator:

A substance that causes muscles in the respiratory system to relax.

Bronchoscope:

A device consisting of a long thin tube with a light and camera on the end for looking into a patient's airways and lungs

Pulmonary:

Pertaining to the lungs.

Respiratory system:

The nose, tonsils, larynx, pharynx, lungs, and other structures used in the process of breathing.

Toxic:

Poisonous.

SYMPTOMS

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Some symptoms of smoke inhalation are visible to the naked eye. For example, nose hairs may be burned and there may be burns on the throat and inside the nose. The throat may also begin to swell up.

Smoke inhalation causes other obvious symptoms including noisy breathing, coughing, hoarseness, black or gray saliva (spit), and fluids in the lungs. A person who is not receiving enough oxygen may become short of breath and may develop a bluish-gray or cherry-red skin color. As the condition becomes worse, the patient may lose consciousness or stop breathing.

DIAGNOSIS

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Diagnosis of smoke inhalation is based on personal history and physical examination. In most cases, the patient will visit a doctor because he or she has been present at a structural fire. The possibility of smoke inhalation will be clear. In the case of a smoker, this connection may not be so obvious.

A physical examination may reveal some or all of the symptoms listed above. In addition, the doctor can listen to the patient's chest and take his or her pulse rate. Smoke inhalation may cause abnormal chest sounds and a decreased pulse rate.

Blood tests may also be taken. A blood test can show the amount of oxygen in the blood. It can also show if toxic gases from the smoke are present in the blood. A chest X ray will not show damage to the respiratory system but it may show the presence of fluids in the lungs.

FIRE SPRINKLER SYSTEMS

The first fire sprinkler system was built in 1874 by the American inventor Henry S. Parmalee. He developed the system to protect the factory in which he built pianos.

Sprinkler systems soon became popular in large factories and warehouses. But they did not seem to have any use in the large majority of office buildings and other structures. They were much too expensive to build.

Attitudes about sprinkler systems began to change in the 1940s. A number of horrible fires were responsible for this change. Perhaps the most important was a fire that struck the Coconut Grove Night Club in Boston in 1942. In that fire, 492 people were killed, many by smoke inhalation.

Before long, city governments began to insist on sprinkler systems in all new office and apartment buildings. For example, New York City requires such systems in all high-rise buildings. The city of Chicago requires sprinkler systems in all nursing homes. Some communities even require sprinkler systems in private homes. San Clemente, California, is one such community.

Damage to the patient's airways and lungs can be viewed directly with a bronchoscope. A bronchoscope is a device that consists of a long thin tube that can be inserted into the patient's respiratory system. The doctor can look through the tube directly into the windpipe and lungs to see if damage has occurred to tissues.

TREATMENT

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The primary goal in treating smoke inhalation is to make sure that the patient is getting enough oxygen. Two steps may be necessary to achieve this objective. First, the patient's airway has to be kept open. In some cases, the patient may be breathing easily and normally. This condition suggests that the airway is open and functioning normally. In that case, all that may be necessary is to give the patient oxygen through a mask that delivers pure oxygen or air enriched with oxygen to his or her body.

If the patient is wheezing, his or her airway may be constricted (narrowed) or blocked. In that case, the first step is to open up the airways. One way to do this is to give the patient a bronchodilator (pronounced brahng-KO-DI-lay-tor). A bronchodilator is a substance that causes muscles in the respiratory system to relax. As they relax, the tubes through which air gets

into the lungs become larger. The patient is able to breathe more easily. At this point, oxygen may also be given.

In some cases it may be necessary to insert a tube into the patient's respiratory system through the nose. Oxygen can then be provided through the tube.

Other forms of treatment may be necessary also. For example, the smoke inhaled may have contained certain toxic substances. Blood tests will often show the presence of these toxic substances in the blood. They can then be treated with other substances that will react with the toxic materials and make them harmless.

PROGNOSIS

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The key to complete recovery from smoke inhalation is often prompt treatment. People with relatively moderate symptoms who receive early treatment tend to recover completely from the experience. In some cases, however, patients may develop chronic respiratory or pulmonary (lung) disorders. Patients most at risk for such disorders are those who had respiratory problems such as asthma (see asthma entry) before exposure to smoke. Those patients are likely to experience more severe symptoms of their disorder than they did before the smoke inhalation.

PREVENTION

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Avoiding smoke inhalation may be difficult because, of course, people usually do not choose to be present in a burning building. The best way to avoid smoke inhalation, then, is to prevent the structural fires that create the problem. Structural fires are best prevented by the use of safe electrical wiring, proper storage of flammable materials, maintenance of clean, well-ventilated chimneys and wood stoves, and other basic fire safety practices.

The damage caused by structural fires can often be reduced dramatically by the installation of smoke detectors and sprinkler systems. Studies have shown that more than 98 percent of all potentially disastrous fires can be prevented by properly installed sprinkler systems.

Finally, fire fighters should be provided with and trained in the use of proper protective gear to avoid the problems of smoke inhalation.

FOR MORE INFORMATION

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Web sites

"Fire Sprinkler Facts." [Online] http://www.waycool.com/southwest/intro.html (accessed on November 5, 1999).

"Homeowners Guide to Fire Sprinkler Systems." National Fire Sprinkler Association Home Page. [Online] http://www.nfsa.org/homeown.html (accessed on November 5, 1999).

Johnson, Norma Jean. "Smoke Inhalation." [Online] http://www.emedicine.com/EMERG/topic538.htm (accessed on November 5, 1999).