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Practical Procedures

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This article – the fourth in a six-part series on first-aid procedures – explains the first line of treatment for a casualty who has inhaled fumes.

Authors Phil Jevon, BSc, RN, is resuscitation officer/clinical skills lead; Lisa Cooper, MSc, RN, is advanced nurse practitioner, A&E; both at Manor Hospital, Walsall.

Inhalation of fumes such as smoke, gases (for example, carbon monoxide) and toxic vapours can be life-threatening so urgent medical attention will need to be sought. If safe to do so, first aid should be provided with particular emphasis on ensuring the safety of the rescuer and moving the casualty to a place of fresh air (St John Ambulance et al, 2006).

Smoke and toxic fumes
Smoke is the most common cause of inhalation injury and is associated with burns injuries in house fires (Wyatt et al, 2006). Smoke inhalation can cause both thermal and chemical injuries to the respiratory system, with varying degrees of systemic toxicity (Jevon, 2006).
Smoke-inhalation injuries are the leading cause of fire fatalities. The major forms of inhalation injury are carbon monoxide toxicity, injury to the upper airway and pulmonary parenchymal damage. Life-threatening complications include acute pulmonary insufficiency, pulmonary oedema and bronchopneumonia (Latenser and Iteld, 2001).
Smoke contains very little oxygen as this is used up by the burning of the fire. It may contain toxic fumes produced during the combustion of household materials. Examples of these include (Ramrakha and Moore, 2004):

  • Sulphur dioxide and nitrogen dioxide (from wood and petrol products);

  • Hydrochloric acid (from polyvinyl chloride);

  • Toluene disocyanate (from polyurethane).

The signs and symptoms of smoke and toxic fume inhalation include (Ramrakha and Moore, 2004):

  • Cough;

  • Sore throat;

  • Breathlessness;

  • Chest pain (pleuritic and retrosternal);

  • Headache;

  • Dizziness;

  • Nausea.

Carbon monoxide
Carbon monoxide (chemical formula: CO) is a gas that results from the incomplete burning of fuels such as gas, oil, coal and wood. When a fire burns in an enclosed room, the oxygen is gradually used up and replaced with carbon dioxide. Following a build-up of carbon dioxide in the air, the fuel is prevented from burning fully, which leads to carbon monoxide being released into the atmosphere (NHS Direct, 2007).
Carbon monoxide is poisonous and even breathing in a small amount can cause loss of consciousness and death. In the UK, over 50 people die each year from accidental carbon-monoxide poisoning and 200 are seriously injured (NHS Direct, 2007). Such poisoning causes 85% of fire-related deaths (Wyatt et al, 2006).
The gas is hard to detect because it has no smell, taste or colour. This means it is very easy for individuals to inhale it without realising they are doing so. After inhalation, the gas combines with the haemoglobin, producing a compound called carboxyhaemoglobin. The signs and symptoms of carbon-monoxide poisoning include headaches, drowsiness, tachycardia and tachypnoea as well as loss of consciousness (Ramrakha and Moore, 2004). The ‘classic’ sign of cherry-red mucous membranes is rarely seen and clinically unreliable (Jevon, 2006).

First-aid treatment of inhalation of toxic fumes

  • Ensure it is safe to approach. Only undertake a rescue if it is safe to do so. Fumes that have built up in a confined space can quickly and easily overcome a rescuer who is inadequately protected;

  • Alert emergency services, contacting both the ambulance and fire services (St John Ambulance et al, 2006) (Fig 1);

  • Escort the casualty away from the source of the smoke or fumes to a place of fresh air (Jevon, 2006) (Fig 2);

  • Encourage the casualty to sit up as this will facilitate their breathing, and loosen
    any tight clothing from around their neck (Fig 3);

  • Reassure the casualty and stay with them until expert help arrives;

  • Regularly monitor the casualty’s vital signs, for example, respiratory rate, pulse rate and level of consciousness (Fig 4). In cases of smoke-inhalation injury in particular, monitor the casualty’s breathing because upper-airway complications, such as mucosal swelling, can develop and can compromise the airway;

  • If the casualty’s level of consciousness deteriorates, place them in the recovery position (Fig 5) and continue to monitor
    their vital signs. If they stop breathing at
    any point, start resuscitation, taking care
    to ensure they are not exposed to any more toxic fumes;

  • If carbon-monoxide poisoning is suspected, for example, there is evidence of vehicle exhaust fumes in an enclosed garage, open the garage doors and let the gas escape before entering (St John Ambulance et al, 2006) (Fig 6).

Professional responsibilities
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.

Jevon, P. (2006) Emergency Care and First Aid for Nurses. Oxford: Elsevier.

Latenser, B., Iteld, L. (2001) Smoke inhalation injury. Seminars in Respiratory and Critical Care Medicine; 22: 1, 13–22.

NHS Direct (2007) Carbon Monoxide Poisoning.

Ramrakha, P., Moore, K. (2004) Oxford Handbook of Acute Medicine. Oxford: Oxford University Press.

St John Ambulance et al (2006) First Aid Manual. London: Dorling Kindersley.

Wyatt, J. et al (2006) Oxford Handbook
of Emergency Care. Oxford: Oxford University Press.

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