Carbon Monoxide Archives - Jeffrey Sterling, MD

Straight, No Chaser: Your Questions on Treatment of Fire Related Injuries

Questions, you’ve got questions (Why are you so shy about posting them?). Here we go. Today, your focus is on the aftermath and treatment of fire related injury.
1) What does carbon monoxide poisoning look like?

Carbon Monoxide (CO) poisoning is very dangerous because the gas is colorless and odorless. You should suspect that you’re feeling its effect when you’re feeling like you have the flu after perhaps being in a contained area with a motor running or after a fire. Headache is the most common symptom, and you may also feel nauseated, with malaise (feeling ‘blah’) and fatigue also being common symptoms.

2) How are the burns treated?

Burns cause serious illness. The thermal component can cause direct damage to your airway. The toxins contained within (carbon monoxide and cyanide) can kill you independent of any other consideration. Burns are especially prone to infection, so you don’t want significant skin burns exposed to everything outside of a burnt house while you’re waiting for the ambulance.
The burns will be treated according to the severity. A lot of intravenous fluid, pain management, clear blister removal and infection control will be in order. Especially serious burns may require a burn unit and skin grafting.

3) What can I do to treat while waiting for the ambulance?

Keep calm, and keep them calm.
Be prepared to start CPR if necessary.
If any injuries have occurred to the head and neck, lay the person down and don’t move them.
Cover any bleeding areas, and apply enough pressure to stop external bleeding.
If you have a clean sheet, wrap the person in it.

4) I know someone who says she was intubated (i.e. had a ‘breathing tube’ placed), and they were feeling fine after a fire. Why would this have been done?

It’s hard to comment on the management of individual cases sight unseen, but most likely soot or burning was noted somewhere inside the airway (e.g. the mouth, nose or oral cavity). Intubation would have been done to protect and secure the airway before in collapses. If you wait until the last possible moment, it could be too late.

Straight, No Chaser: The Roof Is On Fire – The Trauma of Residential Fires

As Trauma Week winds down on Straight, No Chaser, we work our way back home, which sadly is the site of most traumatic injuries. In fact, about 85% of all U.S. fire deaths occur in homes.
The good news is the number of residential fire-related deaths and associated injuries is going down, but that won’t help you if you aren’t aware of how to prevent them and get to safety and cared for in the event a fire occurs in your home. Let’s address this right off the bat. You’re most likely to die or be injured from a fire if you’re in one of the following groups, according to the Center for Disease Control (but of course, the fire doesn’t check who’s being burnt):

Poor
Rural
African-American
Native American
Ages less than 4 or over 65

In the U.S. (2010 data), someone dies every 169 minutes and is injured every 30 minutes, amounting to over 2,500 deaths and over 13,000 injuries (and that’s not including firefighters). Interestingly, victims aren’t burning to death as much as they are dying from inhalation injuries from smoke and gases (estimated to be the cause of death in between 50-80% of cases). Speaking of smoke, although cooking is the #1 cause of fires, smoking is the leading cause of fire-related deaths. Alcohol consumption is a contributing factor in 40% of residential fire deaths. Most fires occur in the winter.
So What To Do?

Install a smoke alarm. They work. Over one-third of residential fire deaths occur in homes without alarms.
Plan your escape in advance. Have an exit strategy based on where a fire might break out in your home.
Don’t fight the fire. Nearly ½ of fire related injuries occur from efforts to fight the fire. Get out of the house. Of course if you have easy access to an extinguisher, use at your discretion.

Tips on How You’ll Be Treated
Fire-related injuries commonly involve burns and bony injuries (bruises, sprains, fractures), which will be addressed as needed. However, the most important fire-related injuries involve the airway. These injuries may be due to the heat’s effects on the airway (burns, swelling and inflammation) and/or the effects of carbon monoxide and/or cyanide (inability to oxygenate). One important fact for families to realize is the presence of any soot/burns anywhere near or in the mouth or nose needs to be evaluated. Such signs and symptoms are powerful predictors of potential airways damage and imminent failure.