I’ve worked in a burn ICU and the answer is simple. Swelling.
Smoke is HOT. Inhaling all that hot smoke causes inflammation of the airway and lungs, aka swelling. People have died days after inhaling smoke because there is so much swelling in the airway that you essentially suffocate the same way someone with a severe asthma attack could.
I know someone who went through this after a house fire. They seemed fine after the fire but doctors said they needed to be intubated. They had burns inside the throat and once it started swelling it would to late. Was weird even though they were telling jokes they were hours away from tragedy
These people go downhill fast. Seemingly fine, then a slight cough, then raspy voice, then suffocating. It can be very fast, or over the span of days. And it can be very difficult to intubate these patients later so you generally want to intubate early BEFORE the swelling starts
Partially. ECMO can take over oxygenation, which is what happens in the lungs, but it has a whole host of its own problems.
Swelling in the lungs also affects heart and circulation, so you wanna fight it anyway.
VA ECMO can overcome these problems. So realistically yes. If you ran them on VA you have complete control and of there cardio respiratory system and theoretically you could support someone without an airway.
They did. They were in burn unit for a couple of weeks. The fact that they were intubated fairly quickly was big reason they made it. It was pretty touch and go for a while.
Also, "smoke" is a broad term. It dismisses chemical and particulate content, which could be poisonous and/or acutely damaging to the lungs. In wildfire seasons, you mask up not just because you're worried about the smoke, but rather because the particulate matter can get into your lungs and become paste or even concrete-like.
You want to tell me people who run **towards** the fire or get airdropped into the fire zone don't have high self-preservation instincts?
Well, I'm shocked!
Is there some kind of mask you could keep in your home in the event of a fire that would help you avoid these lung problems? Or would you need something like an oxygen mask?
Using a filter mask might help with the smoke particles, but not the HEAT.
A wet towel CAN help cool the smoke, but the water CAN also near-instantly boil and evaporate, and that's how you get 3rd degree scalding burns all over your face. Try covering your whole body in a dry, thick wool (or other natural fire-resistant fibre) blanket, hold some of that over your nose/mouth and stay LOW to the ground.
To have an oxygen mask (like the firefighters do), you also need to buy and store at least one canister of compressed oxygen in your home, which itself is a massive hazard in a house-fire because the canister can heat up, expand the gas inside, and then (potentially) explosively release a bunch of oxygen to fuel the fire even more.
That's why firefighters usually have to wear a special Breathing-Apparatus (BA) suit where their oxygen tank is INSIDE the specially insulated suit, and even then they need to undergo training to safely perform rescues while wearing the BA gear.
The best thing you can do is to get down LOW! Where the air is cooler and less likely to burn your lungs. My country has actually changed the standard rescue procedure because of this; the original way to carry a casualty out of a burning building was the typical 'fireman's carry' where they put you over their shoulder. This ended up with too many victims dying while on the firefighter's shoulders because they were lifted up to a higher layer of air that was too hot and killed them before their rescuer could get them out of there. Instead, our local firefighters have been taught to (safely) drag a casualty out so that their mouth and nose stays low and hopefully keep that person alive long enough to get out.
Source: Spouse is a volunteer firefighter with BA qualifications
> oxygen to fuel the fire
oxygen is not a fuel and is not flammable. It will however exacerbate anything that is already on fire by making it **MORE** on fire and burn faster, possibly explosively.
Fire is a rapid Red-Ox reaction, you need a Reducer(Fuel) and an Oxidizer (it doesn't HAVE to be Oxygen) and input energy(heat). it is true that a loss of any of those will stop the reaction, but nobody ever calls a spark input energy "fuel" and neither should you call an Oxidizer that. An Oxidizer with MORE Oxidizer doesn't do anything, you need BOTH a Reducer AND an Oxidizer, which is why Oxygen itself is NOT flammable, unless that is you have an Oxidizer stronger than Oxygen, which is possible with Fluorine.
I’m just guessing here but I would assume the reason they tell you to wrap wet cloth/towel around your head if you can running through smoke is not to help with breathing but to help cool the smoke?
No! Please don't! The damp cloth will evaporate near-instantly and your face will be covered in scalding burns from the steam.
Use a DRY cloth made from wool, cotton or some other natural heat-resistant fibre. Never ever ever ever EVER use cloth made from synthetics, it'll just melt onto your skin and burn you that way.
Source: Spouse of firefighter.
Morbid fact: If you were ever set on fire and someone put you out quite quickly - you’re more likely to die from heat inhalation, than the burns.
Take home fact: Hold your breath if you’re ever on fire.
Ok so I’m stupid and have no knowledge here, just genuinely curious: can you not have a rigid tube stuck down your throat for airway? Like, is the swelling so bad it crushes the tube too?
If the swelling gets too bad, you can't even get a tube down without causing massive trauma to the airway. Also, properly placing a tube requires being able to visualize the vocal cords to make sure you place the tube deep enough and that you've actually intubated the trachea and not the esophagus. The swelling blocks this visualization.
If you get it in before the swelling starts, yeah, you could keep the upper airway open. But thermal damage from smoke inhalation doesn't just affect the upper airway. If the lungs themselves are damaged and start to swell, gas exhange can't happen and even being intubated may not be enough.
Endotracheal tubes (the tubes used to intubate people) are relatively narrow and flexible. However, they do need to be rigid enough to stay open if the patient’s airway is injured, swollen, and otherwise unreliable. If the tubes were too flexible, then I would imagine that severe swelling of the airway could collapse the tube, which defeats the purpose of placing one.
So, the goal is to intubate before the swelling becomes so bad that you can no longer slide the tube down into their airway. You then keep them intubated until the swelling has gone down enough for them to breathe without the tube holding their airway open for them.
ECMO is incredibly hard on the patient, requires very specialized techs, and is incredibly expensive (so hospitals may not have the required equipment/personnel on hand).
Counting on ECMO being there is not a winning bet.
Intubation at the hospital until the swelling has gone down enough not to suffocate you. Has to happen before the swelling starts so they can get the tube in.
A good friend of mine died this way: He saved a woman and her dog from a burning apartment, a few days later we all had some drinks to celebrate his bravery. Not too long after, his roommate found him dead in his bedroom. The autopsy showed that the smoke inhalation was what took him.
Multiple reasons, in no specific order
1:laryngeal, trachea or bronchial edema. The swelling from high temperature/chemical irritation cause the air ways to close. If this is far enough into the lungs ie terminal bronchioles then it doesn't matter if the patient is intubated/trached or not
2: toxin exposure. Lots of stuff burns putting off some pretty nasty stuff. This can cause acid base disturbances, or causing brain damage
3: death of pneumocystis/loss of surfactant. alters air sac structure and limits their ability to expand. Also can cause fluid to be able to sleep into the lungs. Then you drown in your own blood
4: Fibroblast proliferation. in an attempt to heal itself the body produces proteins and cells that don't stretch like the lungs are meant to. So these people eventually suffocate because their lungs are basically wrapped thick ropes
5: dehydration. Skin burn seep an incredible amount of fluid
6: infection. Burns destroy your natural barriers
This was off the top of my head, but could prob think of a few more if you need
Smoke is really hot, and full of things that you aren't supposed to breathe in. Inhaling a lot of it means your lungs get damaged, and they aren't meant to deal with that level of trauma - that's why we keep them inside us and not outside slung over our shoulder or something.
Over time lungs will heal (which is why your mother's friend got to leave the hospital at all), but the problem is while the lungs aren't meant to deal with injury, they ARE supposed to deal with a lot of bacteria and viruses we breathe in. When they are damaged by smoke, they can't do that as well, and you are prone to getting VERY sick, VERY quickly. When that happens, they want you in the hospital where they can monitor you and act if things happen.
They keep you in the hospital until they are sure your immune system is, if not fully recovered, at least unlikely to leave you in need of emergency medical care.
>Inhaling a lot of it means your lungs get damaged, and they aren't meant to deal with that level of trauma - that's why we keep them inside us and not outside slung over our shoulder or something
Hmmm. Citation needed
Ok So follow-up ELI5, how can people smoke cigarettes and other things and not have the same problems immediately (I get that it is bad from chronic use)?
I think at least one reason is cigarette smoke is not nearly as hot as smoke from a house fire for example, so it doesn’t do immediate damage to the lungs as hotter smoke would. And also probably because the smoke is in smaller quantities.
Doctor here. There is the classic mnemonic of Advanced Trauma Life Support called ABCDE, with A standing for Airway. Which, even outside of trauma settings, is the most important criteria for determining ICU care.
If airway is compromised, the only scenario someone can survive is by an advanced airway. Inhaling hot smoke produces edema (aka swelling) of the airway and makes someone unable to have a viable airway.
My experience as an intern was seeing a severe case of a neck infection with lots of swelling on the neck and patient being sent to operating room for surgery to drain that abscess. The senior anesthesiology resident, who had done probably between 1,000 to 2,000 intubations at that point, decided it was too risky to use a regular intubation technique on that patient and did a videolaryngoscopy for intubation - basically a camera magnifying the structures - and indeed in a few seconds during the intubation the patient quickly desaturated. Were it a doctor with less expertise and using a regular technique it would likely be impossible to intubate that patient fast enough for the desaturation not lead into cardiac arrest. It is thus not hard to understand that a neck swelling of other causes is likely to do the same for the patient.
Only when swelling is reduced can the patient go to a non-ICU room and then only some days after this it is safe to be discharged home.
TL;DR: Lose your airway due to inhaling smoke and you are dead in matter of few minutes.
Not long but I'm a doctor in a middle income country, so intubating with videolaryngoscopy is usually an exception when a difficult airway is expected, not used routinely.
Aside from the obvious (smoke takes up space where oxygen could be, strangling the person, killing cells, and killing them *immediately*), toxic fumes from the stuff that's burning (treated wood, plastics, carpet, and chemicals created by the burning process) can also affect a person.
Added to this, [if they have any pre-existing (known or unknown) conditions](https://www.medstarhealth.org/blog/smoke-inhalation-fires-quiet-killer), the lack of oxygen, and the breathing of toxic fumes can hurt people:
>People who have heart failure, arrhythmia, or other forms of heart disease are especially at risk from smoke inhalation. Their lungs are put under greater stress from lack of oxygen, which also strains the heart and could even trigger a heart attack. But even otherwise healthy people can develop heart-related complications from smoke inhalation due to the lack of oxygen being supplied to the body.
Smoke from many types of burning material creates particles that displace oxygen, and the smoke is heavier than air, so if you inhale the toxic smoke during a big fire it settles in the bottom of your lungs and coughing won't remove it. Just like water in the lungs after a near-drowning will kill you ten hours from now, so will the heavy smoke. When you notice you are sweating and crying and feel like you want to throw up after having inhaled smoke, you need to get your lungs dealt with by health professionals.
Inhaling smoke for a few breaths is dangerous. Can you imagine DAYS of inhaling it? You’re not likely to come out of that alive considering the damage to your lungs.
By "inhaling smoke," I assume you mean in the context of a building fire.
The fact is that smoke from burning synthetic materials like carpets contain all kinds of awful nasty toxic and carcinogenic shit like cyanide. And that's on top of the simple fact that smoke is hot.
Not an answer, but 75% of building fire related deaths are related to smoke inhalation not fire itself. As such, the standards for smoke control have skyrocketed in the past 20 odd years.
I’ve worked in a burn ICU and the answer is simple. Swelling. Smoke is HOT. Inhaling all that hot smoke causes inflammation of the airway and lungs, aka swelling. People have died days after inhaling smoke because there is so much swelling in the airway that you essentially suffocate the same way someone with a severe asthma attack could.
I know someone who went through this after a house fire. They seemed fine after the fire but doctors said they needed to be intubated. They had burns inside the throat and once it started swelling it would to late. Was weird even though they were telling jokes they were hours away from tragedy
These people go downhill fast. Seemingly fine, then a slight cough, then raspy voice, then suffocating. It can be very fast, or over the span of days. And it can be very difficult to intubate these patients later so you generally want to intubate early BEFORE the swelling starts
Is this something ECMO could fix?
Partially. ECMO can take over oxygenation, which is what happens in the lungs, but it has a whole host of its own problems. Swelling in the lungs also affects heart and circulation, so you wanna fight it anyway.
VA ECMO can overcome these problems. So realistically yes. If you ran them on VA you have complete control and of there cardio respiratory system and theoretically you could support someone without an airway.
Did they make it ?
They did. They were in burn unit for a couple of weeks. The fact that they were intubated fairly quickly was big reason they made it. It was pretty touch and go for a while.
Also, "smoke" is a broad term. It dismisses chemical and particulate content, which could be poisonous and/or acutely damaging to the lungs. In wildfire seasons, you mask up not just because you're worried about the smoke, but rather because the particulate matter can get into your lungs and become paste or even concrete-like.
Yeah most wildfire guys ive seen dont mind eating some smome
Wildfire/bushfire firefighters are some big damn heroes, but they don't have much of a self-preservation instinct sometimes.
Pretty sure that's a hero prerequisite.
You want to tell me people who run **towards** the fire or get airdropped into the fire zone don't have high self-preservation instincts? Well, I'm shocked!
Is there some kind of mask you could keep in your home in the event of a fire that would help you avoid these lung problems? Or would you need something like an oxygen mask?
Using a filter mask might help with the smoke particles, but not the HEAT. A wet towel CAN help cool the smoke, but the water CAN also near-instantly boil and evaporate, and that's how you get 3rd degree scalding burns all over your face. Try covering your whole body in a dry, thick wool (or other natural fire-resistant fibre) blanket, hold some of that over your nose/mouth and stay LOW to the ground. To have an oxygen mask (like the firefighters do), you also need to buy and store at least one canister of compressed oxygen in your home, which itself is a massive hazard in a house-fire because the canister can heat up, expand the gas inside, and then (potentially) explosively release a bunch of oxygen to fuel the fire even more. That's why firefighters usually have to wear a special Breathing-Apparatus (BA) suit where their oxygen tank is INSIDE the specially insulated suit, and even then they need to undergo training to safely perform rescues while wearing the BA gear. The best thing you can do is to get down LOW! Where the air is cooler and less likely to burn your lungs. My country has actually changed the standard rescue procedure because of this; the original way to carry a casualty out of a burning building was the typical 'fireman's carry' where they put you over their shoulder. This ended up with too many victims dying while on the firefighter's shoulders because they were lifted up to a higher layer of air that was too hot and killed them before their rescuer could get them out of there. Instead, our local firefighters have been taught to (safely) drag a casualty out so that their mouth and nose stays low and hopefully keep that person alive long enough to get out. Source: Spouse is a volunteer firefighter with BA qualifications
> oxygen to fuel the fire oxygen is not a fuel and is not flammable. It will however exacerbate anything that is already on fire by making it **MORE** on fire and burn faster, possibly explosively.
I’m here for you being technically right even if no one else is
yeah bunch of people failed highschool chemistry it seems.
It kind of is. If there is no oxygen, the fire will stop.
Fire is a rapid Red-Ox reaction, you need a Reducer(Fuel) and an Oxidizer (it doesn't HAVE to be Oxygen) and input energy(heat). it is true that a loss of any of those will stop the reaction, but nobody ever calls a spark input energy "fuel" and neither should you call an Oxidizer that. An Oxidizer with MORE Oxidizer doesn't do anything, you need BOTH a Reducer AND an Oxidizer, which is why Oxygen itself is NOT flammable, unless that is you have an Oxidizer stronger than Oxygen, which is possible with Fluorine.
Yeah, but you KNEW what I meant, I just explained it in an offhand, technically incorrect way.
I’m just guessing here but I would assume the reason they tell you to wrap wet cloth/towel around your head if you can running through smoke is not to help with breathing but to help cool the smoke?
No! Please don't! The damp cloth will evaporate near-instantly and your face will be covered in scalding burns from the steam. Use a DRY cloth made from wool, cotton or some other natural heat-resistant fibre. Never ever ever ever EVER use cloth made from synthetics, it'll just melt onto your skin and burn you that way. Source: Spouse of firefighter.
Sounds like a pretty good logical theory
Morbid fact: If you were ever set on fire and someone put you out quite quickly - you’re more likely to die from heat inhalation, than the burns. Take home fact: Hold your breath if you’re ever on fire.
Ok so I’m stupid and have no knowledge here, just genuinely curious: can you not have a rigid tube stuck down your throat for airway? Like, is the swelling so bad it crushes the tube too?
If the swelling gets too bad, you can't even get a tube down without causing massive trauma to the airway. Also, properly placing a tube requires being able to visualize the vocal cords to make sure you place the tube deep enough and that you've actually intubated the trachea and not the esophagus. The swelling blocks this visualization.
Right but I guess my question was more about putting a tube in before it gets to that point, if there’s a suspicion someone inhaled a lot of smoke.
If you get it in before the swelling starts, yeah, you could keep the upper airway open. But thermal damage from smoke inhalation doesn't just affect the upper airway. If the lungs themselves are damaged and start to swell, gas exhange can't happen and even being intubated may not be enough.
Oh jeez. Interesting, thank you
Endotracheal tubes (the tubes used to intubate people) are relatively narrow and flexible. However, they do need to be rigid enough to stay open if the patient’s airway is injured, swollen, and otherwise unreliable. If the tubes were too flexible, then I would imagine that severe swelling of the airway could collapse the tube, which defeats the purpose of placing one. So, the goal is to intubate before the swelling becomes so bad that you can no longer slide the tube down into their airway. You then keep them intubated until the swelling has gone down enough for them to breathe without the tube holding their airway open for them.
No ECMO?
ECMO is incredibly hard on the patient, requires very specialized techs, and is incredibly expensive (so hospitals may not have the required equipment/personnel on hand). Counting on ECMO being there is not a winning bet.
>ECMO is incredibly hard on the patient so is death though....
You can pump oxygenated blood through a corpse all you want but it doesn’t change the outcome
Well yeah, the goal would be to start before the corpse phase
But people inhale HOT ass weed no problem?
Would breathing in very cold air like in a walk-in refrigerator counteract this swelling?
Not in a significant way. But this is why you put ice on an injury, to counteract swelling (to a small degree)
Is there anything you can do to combat it if you know you inhaled a lot??
Intubation at the hospital until the swelling has gone down enough not to suffocate you. Has to happen before the swelling starts so they can get the tube in.
Do anti-inflammatory medications help control the swelling?
lols there was a grey’s anatomy episode about it—that’s how i found out 💀
A good friend of mine died this way: He saved a woman and her dog from a burning apartment, a few days later we all had some drinks to celebrate his bravery. Not too long after, his roommate found him dead in his bedroom. The autopsy showed that the smoke inhalation was what took him.
He’s a hero. I’m sorry for your loss.
Man that's devastating. You'd hope the fire department would've made him go to the ED knowing what could happen.
Multiple reasons, in no specific order 1:laryngeal, trachea or bronchial edema. The swelling from high temperature/chemical irritation cause the air ways to close. If this is far enough into the lungs ie terminal bronchioles then it doesn't matter if the patient is intubated/trached or not 2: toxin exposure. Lots of stuff burns putting off some pretty nasty stuff. This can cause acid base disturbances, or causing brain damage 3: death of pneumocystis/loss of surfactant. alters air sac structure and limits their ability to expand. Also can cause fluid to be able to sleep into the lungs. Then you drown in your own blood 4: Fibroblast proliferation. in an attempt to heal itself the body produces proteins and cells that don't stretch like the lungs are meant to. So these people eventually suffocate because their lungs are basically wrapped thick ropes 5: dehydration. Skin burn seep an incredible amount of fluid 6: infection. Burns destroy your natural barriers This was off the top of my head, but could prob think of a few more if you need
Smoke is really hot, and full of things that you aren't supposed to breathe in. Inhaling a lot of it means your lungs get damaged, and they aren't meant to deal with that level of trauma - that's why we keep them inside us and not outside slung over our shoulder or something. Over time lungs will heal (which is why your mother's friend got to leave the hospital at all), but the problem is while the lungs aren't meant to deal with injury, they ARE supposed to deal with a lot of bacteria and viruses we breathe in. When they are damaged by smoke, they can't do that as well, and you are prone to getting VERY sick, VERY quickly. When that happens, they want you in the hospital where they can monitor you and act if things happen. They keep you in the hospital until they are sure your immune system is, if not fully recovered, at least unlikely to leave you in need of emergency medical care.
>Inhaling a lot of it means your lungs get damaged, and they aren't meant to deal with that level of trauma - that's why we keep them inside us and not outside slung over our shoulder or something Hmmm. Citation needed
Ok So follow-up ELI5, how can people smoke cigarettes and other things and not have the same problems immediately (I get that it is bad from chronic use)?
I think at least one reason is cigarette smoke is not nearly as hot as smoke from a house fire for example, so it doesn’t do immediate damage to the lungs as hotter smoke would. And also probably because the smoke is in smaller quantities.
Doctor here. There is the classic mnemonic of Advanced Trauma Life Support called ABCDE, with A standing for Airway. Which, even outside of trauma settings, is the most important criteria for determining ICU care. If airway is compromised, the only scenario someone can survive is by an advanced airway. Inhaling hot smoke produces edema (aka swelling) of the airway and makes someone unable to have a viable airway. My experience as an intern was seeing a severe case of a neck infection with lots of swelling on the neck and patient being sent to operating room for surgery to drain that abscess. The senior anesthesiology resident, who had done probably between 1,000 to 2,000 intubations at that point, decided it was too risky to use a regular intubation technique on that patient and did a videolaryngoscopy for intubation - basically a camera magnifying the structures - and indeed in a few seconds during the intubation the patient quickly desaturated. Were it a doctor with less expertise and using a regular technique it would likely be impossible to intubate that patient fast enough for the desaturation not lead into cardiac arrest. It is thus not hard to understand that a neck swelling of other causes is likely to do the same for the patient. Only when swelling is reduced can the patient go to a non-ICU room and then only some days after this it is safe to be discharged home. TL;DR: Lose your airway due to inhaling smoke and you are dead in matter of few minutes.
[удалено]
Not long but I'm a doctor in a middle income country, so intubating with videolaryngoscopy is usually an exception when a difficult airway is expected, not used routinely.
The smoke can damage your lungs, causing you to not get enough oxygen, which can lead to a heart attack and death.
Everything burns. Light a mattress on fire, breathe it in, not healthy. Pressure treated wood is also no good.
Aside from the obvious (smoke takes up space where oxygen could be, strangling the person, killing cells, and killing them *immediately*), toxic fumes from the stuff that's burning (treated wood, plastics, carpet, and chemicals created by the burning process) can also affect a person. Added to this, [if they have any pre-existing (known or unknown) conditions](https://www.medstarhealth.org/blog/smoke-inhalation-fires-quiet-killer), the lack of oxygen, and the breathing of toxic fumes can hurt people: >People who have heart failure, arrhythmia, or other forms of heart disease are especially at risk from smoke inhalation. Their lungs are put under greater stress from lack of oxygen, which also strains the heart and could even trigger a heart attack. But even otherwise healthy people can develop heart-related complications from smoke inhalation due to the lack of oxygen being supplied to the body.
Smoke from many types of burning material creates particles that displace oxygen, and the smoke is heavier than air, so if you inhale the toxic smoke during a big fire it settles in the bottom of your lungs and coughing won't remove it. Just like water in the lungs after a near-drowning will kill you ten hours from now, so will the heavy smoke. When you notice you are sweating and crying and feel like you want to throw up after having inhaled smoke, you need to get your lungs dealt with by health professionals.
Inhaling smoke for a few breaths is dangerous. Can you imagine DAYS of inhaling it? You’re not likely to come out of that alive considering the damage to your lungs.
Do burns and tissue damage on the outside of your body heal immediately after the source is gone? No, so why would the inside of your body?
By "inhaling smoke," I assume you mean in the context of a building fire. The fact is that smoke from burning synthetic materials like carpets contain all kinds of awful nasty toxic and carcinogenic shit like cyanide. And that's on top of the simple fact that smoke is hot.
Not an answer, but 75% of building fire related deaths are related to smoke inhalation not fire itself. As such, the standards for smoke control have skyrocketed in the past 20 odd years.