Beyond the fire: smoke inhalational injury as a respiratory concern

In fire events, smoke inhalation is the leading cause of death in survivors of the primary fire mortality. Direct upper airway thermal injury is only one of the contributing mechanisms. Others may be related to the nature of the combusted (or incomplete combusted) materials in the scene; eg.; aldehydes, sulphur oxides and nitrogen as a cotton combustion products, while burning polyvinylchloride (PVC’s) releases carbon monoxide (CO) and hydrochloric acid, among more than 75 potentially toxic compounds including cyanide. Hot carbonated gaseous materials and soot may lead to supraglottic, glottic, or infraglottic airway obstruction however; significant hypoxemia is not the typical sign in acute cases without aspiration or parenchymal lung injuries. Injury may not manifest until after 48 hours.