Smoke Inhalation

GENERAL INFORMATION:

What is smoke inhalation? Smoke inhalation is a condition where you breathe in harmful smoke. Harmful smoke comes from burning materials and gases, and contains small particles that are suspended in hot air. These small particles include chemicals, irritants, or toxins (poisons), such as carbon monoxide and cyanide. With smoke inhalation, the lungs and airways become irritated, inflamed (swollen), and blocked. The damaged airways and lungs prevent oxygen from getting into your blood, and respiratory failure may then develop. Respiratory failure means you cannot breathe well enough to get oxygen to the cells of your body. Inhaled smoke may also be absorbed into other body organs, such as the heart, brain, liver, and kidneys.

What causes smoke inhalation? Smoke inhalation most commonly happens when you get trapped inside a burning structure. Burning structures include houses, office buildings, and factories. Smoke inhalation may also happen in burning forests, garages, tents, and with campfires. Firefighters may also inhale smoke when doing fire rescues. The following are other possible sources of smoke:

• Bombs or explosives.
  
  
• Burning rubber, coal, plastics, woods, or electrical wiring.
  
  
• Cigarettes and cigars.
  
  
• Exhaust from cars, trucks, and other vehicles.
  
  
• Steam.
  
  
• Stoves, lamps, or fireplaces.

What are the signs and symptoms of smoke inhalation? You may have any of the following:

• Cough and hoarseness.
  
  
• Crackling or wheezing sounds heard by caregivers when listening to your lungs.
  
  
• Headache, abdominal (stomach) pain, and nausea (upset stomach).
  
  
• Problems seeing or thinking clearly. You may also faint (pass out) or have seizures (convulsions).
  
  
• Skin color turning pale, blue, or cherry-red.
  
  
• Soot (black material) in your nostrils or throat.
  
  
• Trouble breathing, such as shortness of breath and noisy breathing.

How is smoke inhalation diagnosed? The diagnosis of smoke inhalation injury depends on the history of smoke exposure. Caregivers need to know the source of the smoke, and that make-up of the burned materials. They also need to know the amount of time that you were exposed to the smoke. You may also need any of the following:

• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Bronchoscopy: This test may be done to look inside your airways and lungs. Caregivers use a bronchoscope to do this test. It is a long tube with a light and magnifying glass on the end. The scope goes in your mouth and into your lungs. Your caregiver may give you medicine for pain or to help you relax during the bronchoscopy. Caregivers may also do a bronchoalveolar lavage through the scope. This is when fluid and cells are sucked up from your lungs to be sent to the lab for tests.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Pulmonary function tests: Pulmonary function tests, also called PFTs, help caregivers learn how well your lungs work. PFTs may also help your caregivers decide on the best treatment for you. During the tests, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers to see how well your lungs are moving and working.
  
  
• V/Q Scan: This is a ventilation (V) and perfusion (Q) test. This test is also called a VP scan. A V/Q scan is a two-part test which takes pictures of your lungs to look for certain lung problems.
  
  
  • During the perfusion part of the test, radioactive dye is put into your vein (blood vessel). The blood carries the dye to the blood vessels in your lungs. Pictures are taken to see how blood flows in your lungs.
    
    
  • During the ventilation part of the test, you breathe in special gas. Pictures are taken to see how well your lungs take in oxygen.

How is smoke inhalation treated? Caregivers may treat you depending on how bad your symptoms are. You may need any of the following:

• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antidotes: These are substances that may stop or control the effects of the harmful smoke you inhaled. Caregivers may give different antidotes depending on the possible cause of your smoke inhalation.
    
    
  • Bronchodilators: You may need bronchodilators to help open the air passages in your lungs, and help you breathe more easily.
    
    
  • Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
    
    
  • Steroids: Steroid medicine may help to open your air passages so you can breathe easier.
  
  
• Respiratory support:
  
  
  • Hyperbaric oxygen therapy: This is also called HBO. HBO is used to get more oxygen into your body. The oxygen is given under pressure to help it get into your tissues and blood. You may be put into a tube-like chamber called a hyperbaric or pressure chamber. You will be able to see your caregivers and talk with them through a speaker. You may need to have this therapy more than once.
    
    
  • Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
    
    
  • Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.

What is the first aid for smoke inhalation?

• Remove the person with smoke inhalation from the fire scene to a place with clean or fresh air.
  
  
• Check if the person is breathing or has a pulse. Start rescue breathing and CPR (basic life support) if needed. Have someone call 911 immediately for medical assistance.
  
  
• Do not return to the area until the fire has been put out and all the smoke has gone.

How can smoke inhalation be prevented?

• Always check the exhaust of your car and never leave the engine running inside the garage. You should also inspect electrical wiring, chimneys, wood stoves, and space heaters in your house. Use flammable liquids safely and store them in a locked area out of the reach of children.
  
  
• Do not leave lit cigarettes unattended, and discard them properly. Keep cigarette lighters and matches locked in a safe place where children cannot reach them.
  
  
• Keep numbers of the police or fire department where you can easily find them. Know where and how to contact your local poison control center.
  
  
• Make an escape plan in case a fire breaks out in your home. Practice it often with your family.
  
  
• Smoke detectors and water sprinklers should be placed in every room of an occupied building. Use smoke detectors in your house, and check them regularly to make sure they are working.
  
  
• When escaping a burning building, crawl to the floor where there is cooler and clearer air to breathe. Keeping close to the floor may help prevent breathing in as much harmful smoke.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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