Burn Injuries and Inhalation Injuries as a Result of Fire

Burn injuries or inhalation injuries from fire have a 10% mortality rate, and greater than 75,000 people are hospitalized annually as a result of burns. Approximately 33% of burn injury patients have additional injuries.

Burn Injuries

Most burns are a result of residential fires. Unusual burns in children may be the result of child abuse. Burns are classified as first-degree, second-degree, or third -degree burns, from least to most extensive. More frequently, burns are classified by thickness of the burn, with first-degree burns considered relatively superficial, such as sunburn. These types of burn causes minimal tissue damage, and may result in peeling without scarring.

Second-degree burns are partial thickness, which means they extend from the top layer of the skin, or the epidermis, to the dermis, which can include blood vessels and nerves. Superficial second-degree burns are painful, red, swollen and blistered. However, they usually heal spontaneously, with the application of a topical antibiotic, and they rarely leave scarring. Deeper second-degree burns may not blister, and may not be as painful. However, they take longer to heal, and usually leave some scars.

Third-degree burns destroy the epidermis and dermis, including hair follicles, blood vessels and nerve endings. For this reason, they may seem almost painless, and the skin will appear waxy or charred. These deep burns will require excision (cutting the dead tissue away) and skin grafting.

If someone is in a fire, a particular danger is inhalation injury. Sometimes inhalation injuries may go unnoticed by an inexperience practitioner. However, inhalation injuries are caused by heat (direct injury), toxic chemicals in smoke, or a combination of the two.

Inhalation Injuries

An inhalation injury can cause the airway to become swollen rapidly and can cause obstruction of breathing. For this reason, if a person exhibits symptoms of airway injury, including hoarseness or difficulty breathing, insertion of an endotracheal, or breathing, tube is recommended immediately in case the airway should close completely and a tube cannot be inserted.

Extreme heat and chemical inhalation may cause extensive injury to the more distal airway, towards the lungs. For this reason, bronchoscopy is performed to assess the extent of the injury, and an endotracheal tube is threaded onto the fiberoptic bronchoscope so an airway can be placed if the injury requires a definitive airways. If there is charred debris in the airway, the airway should be irrigated with saline.

Inhalation injury is the most common cause of death in fires. If someone if trapped in a fire in a closed space, an important consideration is the inhalation of carbon monoxide.

Carbon monoxide replaces oxygen on hemoglobin in the red blood cells, and hemoglobin is the molecule within the red blood cells, which carries oxygen to the tissues. Carbon monoxide is 240 times more likely to adhere to the hemoglobin molecule than oxygen, and thus, oxygen will not be able to attach. Without oxygen, cells die.

In the hospital, burn victims will give a blood sample for a carboxyhemoglobin level, which will indicate the level of carbon monoxide in the blood stream. As the levels of carbon monoxide in the blood stream increase, symptoms will range from headache and nausea to coma and death. Any victim of carbon monoxide inhalation should be placed on 100% oxygen, and may need treatment in a hyperbaric oxygen chamber to displace the carbon monoxide from the hemoglobin in the blood.

Inhalation injuries often may go unsuspected until the airway has swollen shut. Additionally, if carbon monoxide levels are not measured and treated appropriately, this may result in long-term neurologic problems. Even with normal carbon monoxide levels 6 hours or more after an inhalation injury, the patient may benefit from hyperbaric oxygen to prevent long-term sequelae.

If you or a family member has suffered injury as a result of inhalation of heat or toxic chemicals after a fire, and if your injuries have not been appropriately treated, you may suffer long-lasting consequences or even death. If you believe you have suffered an inhalation injury that has not been appropriately treated, you may have been the victim of negligence.

Contact the Burn Injury Firm for a Free Evaluation of your case.