Smoke inhalation

Two cases of smoke inhalation injury are reported with a brief review of the pertinent literature. The frequency of occurrence, the mortality rate, the clinical course of this common event are discussed with emphasis on the following facts: 1) Pulmonary injury is often associated with skin burns and, conversely, skin burns, particularly when severe, are accompanied by significant effects on pulmonary function; 2) Domestic fires, which account for most of these casualties, may involve complex exposure to a variety of aggressive agents (CO, HCN, NOx, etc.), causing systemic effects; 3) The clinical course of the most severe occurrences characteristically consists of three phases, namely acute pulmonary insufficiency, pulmonary edema and bronchopneumonia, in sequence; 4) The mortality rates of these clinical phases range at or about 50 per cent; 5) Significant laryngeal edema and even pulmonary edema may follow an interval of several hours, during which both subjective and objective evidence of injury may be minimal or unnoticed; and 6) The determination of carboxyhemoglobin levels often helps in gauging the severity of the exposure and related effects of either immediate or delayed appearance.