Smoke inhalation

Southern California Brush Fire

Q:

With the recent wildfires I’ve heard about multiple people with smoke inhalation. Is this a serious problem, and how does smoke actually cause problems?

A:

Firefighters and ER docs absolutely fear smoke inhalation, because it is actually more likely to kill people than burns. And believe it or not, smoke can stop your breathing in three different ways.

First, fire can use use up all the oxygen in an area, essentially leaving the patient with nothing usable to breath. Unconsciousness, and death, will quickly result.

Second, the chemicals that form in a fire can cause damage to the patients lungs and airway, causing swelling, and suffocation. This can happen in a delayed fashion, and that’s one reason we like to observe patients after exposure.

Third, the chemicals in smoke can actually make it difficult for your body to use the oxygen that is able to get into the lungs and blood. Carbon monoxide is the worst of these chemicals, because it is able to “grab onto” hemoglobin which normally carries your oxygen through the blood, and it won’t let go. Add that to the first two causes, and you’ve got a real problem.

Patients who have been exposed to smoke from a fire may complain of cough, shortness of breath, irritation in the throat, and they may even be confused. I would strongly recommend these patients be evaluated in the hospital right away, and should be brought there by ambulance.

I had a patient who was stuck inside a burning house and was brought in to the ER by ambulance just when he was starting to have trouble breathing. His skin was fine, no burns, but his nose and mouth were caked with soot. Inside his mouth and airway you could see the swelling develop, and you could hear noisy airflow called “stridor.” We had to quickly protect his ability to breath by putting in a plastic “endotracheal tube,” and put him on 100% oxygen. He had to be admitted to intensive care, but he had a good recovery.