You and your team arrive at the scene of a house fire on a snowy winter night. As several firefighters help the family of five evacuate the house, you see thick clouds of smoke pouring out of the windows and chimney. You know it’s possible that several of the occupants have suffered smoke inhalation and will need to be diagnosed and treated immediately. 


House Fires in the Winter

While house fires can happen at any time, they’re most frequent in the winter months, peaking in December, January and February. Many house fires are a result of people’s response to cold weather, with the five leading causes of house fires being: 


  • Cooking 
  • Heating 
  • Electrical fires
  • Smoking 
  • Candles

During a house fire, patients can inhale harmful particles and gases that cause their lungs and airway to swell and block oxygen. This may result in acute respiratory distress and respiratory failure while also causing difficulties for first responders attempting to manage a patient’s airway. 


Due to the increased likelihood of encountering patients with smoke inhalation during the winter months, you must be able to identify the symptoms of smoke inhalation and know how to treat such patients effectively. 


Symptoms of Smoke Inhalation 

Smoke inhalation has many symptoms that range in severity, and patients may display very few symptoms at the scene, making it difficult to diagnose. Because of this, it’s important to be diligent in your examination.  


Some symptoms that may be present are:


  • Soot in the nose or throat 
  • Cough, stridor or hoarseness
  • Abnormal lung sounds, such as wheezing or labored breathing
  • Headache 
  • Neurological symptoms, such as unconsciousness, decreased alertness, nausea or vomiting
  • Low or high blood pressure
  • Burns to the face and neck
  • Swelling or blistering on the mouth
  • Black or gray saliva
  • Chest pain 
  • Giddiness or euphoria 


Treating Patients with Smoke Inhalation

Smoke inhalation requires immediate medical care, as it’s a major determinant of morbidity and mortality in fire victims. If not treated quickly, it can become a complex life-threatening disease that affects every organ in the body.


Once the patient is evacuated from the fire, all clothing, rings, watches and jewelry should be removed immediately, as these items could be contaminated by toxins or cut off patient blood flow in the event of swelling.


After removing potentially contaminated items from the patient, the critical next step is to oxygenate and examine the patient for the symptoms listed above. It’s also important to determine if the patient was trapped in a contained area, as this can increase the likelihood of smoke inhalation. 


If any of the above symptoms are present, it might indicate the need for aggressive airway management. However, a patient must be endotracheally intubated immediately when displaying:


  • An obstructed airway
  • Moderate-to-severe facial or neck burns 
  • Cognitive impairment 


Minimizing Complications of Airway Management in Patients with Smoke Inhalation

Even if a patient doesn’t need to be intubated immediately, a high index of suspicion should be kept, and frequent reevaluations should be performed. 


You should always have a low threshold for intubation with potential smoke inhalation patients, as the airways of these patients can deteriorate quickly. Edema in the lungs will rapidly progress, causing the patency of the airway to quickly decrease and making airway management more difficult over time. By treating a patient as soon as needed, you can reduce the risk of airway management complications.


When intubating, keep the patient’s head elevated to minimize facial and airway edema. The tube should also be carefully secured, as accidentally removing it is easy to do and may be lethal. 


You may encounter increased mucus in smoke inhalation patients. Because of this, it’s important to have the correct equipment on hand to clean the contaminated airway with effective suctioning. The SSCOR DuCanto Cather is designed to work in emergencies and is effective at quickly clearing a patient’s airway before intubation.   


Smoke inhalation presents clear challenges to airway management, as it is difficult to diagnose and can progress quickly. However, remaining diligent in your examination and having the proper equipment will allow you to effectively treat the patient and prevent the situation from developing into a life-threatening one.