Smoke inhalation is the number one cause of death related to fires. It occurs when you breathe in the products of combustion during a fire.  Smoke inhalation damages the body by simple asphyxiation (lack of oxygen), chemical or thermal irritation, chemical asphyxiation, or a combination of these.

Combustion results from the rapid breakdown of a substance by heat (more commonly called burning). Smoke is a mixture of heated particles and gases. It is impossible to predict the exact composition of smoke produced by a fire. The products being burned, the temperature of the fire, and the amount of oxygen available to the fire all make a difference in the type of smoke produced.

Numerous signs and symptoms of smoke inhalation may develop. Symptoms may include:

  • CoughWhen the mucous membranes of the respiratory tract get irritated, they secrete more mucus. Bronchospasm and increased mucus lead to reflex coughing. The mucus may be either clear or black depending on the degree of burned particles deposited in the lungs and trachea.
  • Shortness of breath: This may be caused by direct injury to the respiratory tract leading to decreased oxygen getting to the blood. The blood itself may have decreased oxygen-carrying capacity. This could be the result of chemicals in the smoke or the inability of cells to use oxygen. This can lead to rapid breathing resulting from the attempt to compensate for these injuries.
  • Hoarseness or noisy breathing: This may be a sign that fluids are collecting in the upper airway where they may cause a blockage. Also, chemicals may irritate vocal cords, causing spasm, swelling, and constriction of the upper airways.
  • Eyes: Eyes may become red and irritated from the smoke. The corneas may also have burns on them.
  • Skin color: Skin color may range from pale to bluish to cherry red.
  • Soot: Soot in the nostrils or throat may give a clue as to the degree of smoke inhalation. Inhalation can lead to nostrils and nasal passages swelling.
  • Headache: In all fires, people are exposed to various quantities of carbon monoxide. Even if there are no respiratory problems, carbon monoxide may still have been inhaled. Headachenausea, and vomiting are all symptoms of carbon monoxide poisoning.
  • Changes in mental status: Chemical asphyxiants and low levels of oxygen can lead to mental status changes. Confusion, faintingseizures, and coma are all potential complications following smoke inhalation.


A number of tests and procedures may be done. The tests depends on the severity of the signs and symptoms.

  • Chest X-ray- The initial X-ray may be normal despite significant signs and symptoms. A repeat X-ray may be needed during the observation period to determine if there is delayed lung injury.
  • Pulse oximetry- A light probe is attached typically to the finger, toe, or earlobe to determine the degree of oxygen in the person’s blood. Pulse oximetry has limitations. Low blood pressure, for instance can make it inaccurate if not enough blood is getting to the parts of the body where the probe is attached.
  • Blood tests
    • Complete blood count : This test determines whether there are enough red blood cells to carry oxygen, enough white blood cells to fight infection, and enough platelets to ensure clotting.
    • Chemistries (also called basic metabolic profile): This test reveals the change of pH in the blood that may be the result of interference with oxygen diffusion, transport, or use. Serum electrolytes (sodium, potassium, and chloride) can be monitored. Renal (kidney) function tests (creatinine and blood urea nitrogen) are also monitored.
    • Arterial blood gas: For people with significant respiratory distress, acute mental status changes, or shock, an arterial blood gas may be obtained. This test can help the doctor decide the degree of oxygen shortage.
    • Carboxyhemoglobin and methemoglobin levels: This level should be obtained in all smoke inhalation victims with respiratory distress, altered mental status, low blood pressure, seizures, fainting, and blood pH changes. It is now routinely done in many hospitals whenever arterial blood gas is assessed.



A number of treatments may be given for smoke inhalation.

  • Oxygen: Oxygen is the mainstay of treatment. It may be applied with a nose tube or mask or through a tube put down the throat.
  • BronchoscopyBronchoscopy is a procedure done to look at the degree of damage to the airways through a small scope and to allow suctioning of secretions and debris.
  • Hyperbaric oxygenation (HBO): If the person has carbon monoxide poisoning, hyperbaric oxygenation may be considered. Hyperbaric oxygenation is a treatment in which the person is given oxygen in a compression chamber.

Once the person leaves the hospital, follow-up care is typically arranged. If the condition worsens or doesn’t improve the way it is expected to after discharge, the person should return immediately to the emergency department.

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