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Injury caused by fire is the second leading cause of death in the home. No single cause has a greater impact on that statistic than inhalation injury. The presence of an inhalation injury in a fire victim is a larger factor in patient deaths than the amount or severity of the external burns that victim sustains.

There are over 100 toxic substances in fire smoke. Inhaling these toxins cause internal injury that is often hidden or overlooked due to the distraction of more visible burn trauma. It has been estimated that 50-80% of all fire related deaths are caused by smoke inhalation not burns

Symptoms of smoke inhalation can appear immediately or gradually over the first few days following the fire. Aside from obvious burns to facial openings, other symptoms can include vomiting, nausea, confusion, sleeplessness and saliva mixed with soot. An individual with these warning signs must be evaluated by a trained medical professional immediately.

Smoke inhalation injuries create three major categories of complication. An immediate complication is a decrease in oxygen levels in the victim's tissues. Carbon monoxide instantly binds to hemoglobin in the blood cells. Hemoglobin that carries carbon monoxide can not carry oxygen. By decreasing the amount of oxygen carried in the blood, carbon monoxide poisoning causes tissue damage by hypoxia.

Another immediate complication of smoke inhalation comes from combustibles containing paper, wool, plastics and nylon components among other synthetics. When burned these materials produce cyanide. Cyanide acts in a similar manner to carbon monoxide. Cyanide bonds to ferric ions on the cellular level. This chemical bond blocks metabolism for the individual cells. The result is cellular asphyxiation and death without immediate treatment.

Thermal or heat damage to the upper airway is another common mechanism of injury. Hot gasses within the smoke will char mucous membranes that line air passages in the upper respiratory system. Thermal damage can swell these passages making breathing or clearing obstructions more difficult. Severe damage can cause respiratory failure and then death.

Another major complication is chemical injury to the lungs. Toxic substances in smoke and combustible materials can easily damage lungs. Wheezing and bronchospasms can narrow airways and increase the heart rate. Within a few days, smaller airways will slough off leading to obstruction and pneumonia.

Pulmonary irritation is the final major mechanism of injury to victims of smoke inhalation. Combustion also releases solid chunks of debris or minuscule particles into the air during a fire. These solid bits are then inhaled causing damage to the respiratory system. Inhaled material can physically damage the lungs. The body will also activate its immune system to combat the invasion. The natural inflammatory reaction that occurs can itself cause tissue damage. Increased lymph fluid production in the lungs can lead to respiratory congestion.

Many of the signs and symptoms of smoke inhalation injury are difficult to detect. Treatment by a medical professional after all suspected exposure to smoke inhalation is a prudent course of action. Smoke inhalation injuries are potentially life-long in nature.

Burn injury statistics

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Burn injuries are considered a problem in health care. Burn injuries are in the top five as the leading cause of accidental death in the United States. There are over 200 special burn care units in the United States. Statistics on burn injuries confirm that at least 50% of all burn accidents could have been avoided. There is one out of every 13 fire deaths in the United States that was caused by a child setting a fire. One-third of children preschool age has died by playing with fire. 

There are 2.4 million burn injuries that are reported per year in the United States. There are around 10,000 pediatric burn injuries yearly in the United States. Around 650,000 of the injuries are treated by medical professionals and about 75,000 are hospitalized. Out of the people that are hospitalized, there are 20,000 who have major burns. There are 8,000 to 12,000 who die from these burns.

Burn classification

Burns are categorized into first, second, and third degrees. The first degree burns which are superficial burns are caused on the top layer of skin. Symptoms of the first degree burn are redness in the skin. The burn can be painful and dry. It takes about around a week for the first degree burn to heal on its own. The next burn is the second degree burns which are partial-thickness burns. This type of burn goes under a few layers of skin. The symptoms of this burn are redness, and blisters that appear. It usually takes three to four weeks for it to heal and may leave a scar. The last type of burn is third degree burns which are full-thickness burns. These burns tear down all layers of skin. It can go through the underlying fat, muscle, bone and nerve structures. The symptoms of the burns are brown or black with the essential tissues showing white. Third degree burns are considered as being a serious condition.

One type of burn injury is from radiation. Ultraviolet light and nuclear radiation are causes of radiation burns. When absorbing too much Ultraviolet light, it can result into a burn injury. UV burns can come from tanning beds, too much exposure to X-rays, radiation therapy and too much sunlight. Treatment can include pain control medication to surgery. 

Burn injuries and young children

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There are many potential causes of burn injuries in the modern American home. Burn injuries were listed by the CDC, the Center for Disease Control, as the fifth most common cause of preventable deaths in 2005. The number of people seeking care for burn injuries is around 2 million each year, although many may treat lesser burn injuries by themselves and such as the real number of burn injuries may be much higher. The term "burn" is somewhat generic as heat, chemicals, electricity, radioactivity exposure and sunlight can cause the skin to develop a burn like injury.

Household fires are a major cause of home burn injuries each year. Over 80% of non-military fire deaths are due to a household fire. Household fires may be caused by cooking accidents, improper use of space heaters, and smoking. In fact, smoking is the most common cause of household fires. While household fires often cause a range of severe burns, smoke inhalation is the number one cause of death from household fires. A smoke detector can often be life saving if installed and maintained properly by checking the batteries at least twice a year.

In the home, burns are often caused by thermal injury which may be due to exposure to hot water, cigarettes, hot grease and hot beverages. Children and the elderly are often victims of burns because they might not realize how hot an item is, or may accidentally spill a pot of hot food on themselves in the kitchen. All parents of young children are recommended to keep hot pots and pans out of the reach of children. This may mean turning the pot handles away from the front of the stove, and using the back burners instead of the front burners. Children should not be allowed to play in a kitchen when a parent is cooking. A small child can be burned if placed into a bath tub with water that is too hot. Only lukewarm water should be used when bathing infants.Hot cups of coffee, or cups of any hot liquid, left on a counter top are also a source of burns as children can easily knock these over on to themselves. Moving these items out of the reach of children can decrease the chance of a serious burn.

Electrical hazards are a major source of burns in the home. You should have a professional electrician check your home every nine years to determine if there are any electrical hazards. Chemical burns can be caused by exposure to caustic chemicals, such as those used in cleaning products. To avoid chemical burns, keep all caustic and dangerous liquids and powders locked in a safe place and out of the reach of children. Matches and lighters should also be kept in a locked cabinet away from children.  

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