For two seasons of "This is Us" people have asked the question "How did Jack Pearson die?" Now we know the answer, and it's the cause of death of the majority of structure fire victims: smoke inhalation. "Smoke inhalation is actually a misnomer," said Annette Matherly, Burn Outreach and Disaster Coordinator for University of Utah Health's Burn Center. "They are called inhalation injuries and include the inhalation of superheated gasses, steam, and noxious chemicals."
There are two chemicals that are most dangerous when it comes to inhalation during a structure fire: carbon monoxide and hydrogen cyanide. Carbon monoxide is the better known of the two, causing death by bonding with red blood cells and starving the body of oxygen. Symptoms can include lightheadedness, confusion, headaches, nausea and vomiting. In severe cases coma, seizures, and death are possible. "If CO poisoning is suspected it's important to get a patient on oxygen immediately," said Matherly. "A patient given 100% oxygen will usually be out of danger within a few hours."
Oxygen should also be given to patients suspected of having cyanide poisoning - though this can be harder to detect than CO poisoning. "With CO poisoning we can measure the COHb level in a patient," Matherly said. "Cyanide levels need to be measured with blood test that may not be immediately available."
There are ways to determine if a patient likely has cyanide poisoning though. If they have soot in their nostrils or mouth, seem confused or unresponsive, or have shortness of breath they may be at risk. Left untreated cyanide poisoning can lead to metabolic problems, lactic acidosis or cardiac arrest. "First a patient would be given 100% oxygen," said Matherly. "Then a cyanide antidote may be considered. This is usually administered by first responders prior to hospital admission if poisoning is suspected."
Chemical inhalation is just one component of inhalation injuries. Thermal burns to the mouth and airways, and chemical burns can also occur. All can cause serious injury and possible death. "If you are in a fire is important to try to reduce your inhalation exposure," said Matherly. "Stay low to the ground and get out as fast as you can."
Oh, and remember to always have good batteries in your smoke detectors.