Smoke poisoning

This article is about smoke poisoning. For other types of gas poisoning, see chemical weapon

Classification according to ICD-10
T59.9	Toxic effect of other gases, vapors or other smoke
T58	Toxic effect due to carbon monoxide
ICD-10 online (WHO version 2019)

The smoke inhalation , even smoke intoxication short Rauchgasintox is a poisoning by inhalation of the fire smoke harmful gases contained. Badly drawing ovens, defective boilers and exhaust gases in a garage or other closed rooms can also lead to smoke poisoning.

causes

In the case of building fires , the main cause of death is not the direct exposure to flames, but smoke gas poisoning from the gases produced.

What flue gas is made up of depends primarily on the burning substances and the heat at which they burn. All components of flue gas can be extremely harmful to human health. Usually, however, it is composed of three large groups:

• Irritant gases, such as B. hydrogen chloride or sulfur dioxide , with a corrosive effect on mucous membranes, eyes, respiratory tract, etc. Here, a distinction is made between the subgroups immediate and latency irritant gases. Immediate irritant gases are hydrophilic , irritant gases of the latency type are lipophilic .
• Toxic gases are primarily carbon dioxide (CO ₂ ), which prevents the release of carbon dioxide from the body, as well as carbon monoxide (CO) and cyanide ( hydrocyanic acid , HCN), which prevent oxygen utilization or binding.
• Soot particles and dioxins can cause thermal damage, serve as a transport vehicle for components from the spectrum of irritant gases and release them only after a delay, which causes long-lasting irritation and mechanical shifts.

The proportions in which the gases are produced can hardly be foreseen.

Carbon dioxide, carbon monoxide and hydrocyanic acid are particularly dangerous. In the body through the metabolism nascent carbon dioxide is usually on the large surface air sacs released into the ambient air. If the inhaled air contains carbon dioxide in high concentrations, then this removal is less effective, or even takes place in the opposite direction. Then the body absorbs carbon dioxide through the lungs. In this way a concentration of the gas above 10% leads to death within less than a minute. In the case of CO, it should be noted that due to the high diffusivity in multi-family houses, it often penetrates into neighboring apartments (or basements, see there ) and endangers the residents there, without anything else suggesting the fire in the neighboring apartment. Carbon monoxide binds to hemoglobin with a 250 to 300-fold affinity and thus causes the so-called carboxyhemoglobin (COHb) to no longer be available for oxygen transport. See also carbon monoxide poisoning . Carbon monoxide is slowly absorbed by the body. Cyanide, on the other hand, is absorbed very quickly via the respiratory tract, distributes itself quickly in the body and can lead to death within minutes in high ambient concentrations. It blocks part of the respiratory chain in the body's cells and thus prevents the production of adenosine triphosphate (ATP) as an energy source from the citric acid cycle . The toxic effects of cyanide and carbon monoxide complement each other additively. Sublethal doses of single poisons can together result in a lethal total dose.

Two thirds of all fatal smoke gas accidents happen at night.

Signs

Signs of smoke poisoning are:

• Headache, dizziness, loss of consciousness
• Vomit
• languor
• blue skin and mucous membranes (caution: with carbon monoxide poisoning, often light red skin color!)
• Loss of consciousness , convulsions
• Circulatory and respiratory paralysis

treatment

Severe smoke gas intoxication occurs particularly in closed rooms. If a complete exchange of air is not immediately possible by opening windows and doors in the case of light smoke, or if there is heavy smoke, the scene of the accident may only be entered by trained persons wearing respiratory protection (e.g. fire fighters ). In the case of unconscious persons without signs of life, the basic resuscitation measures must be started. Here, however, mouth-to-mouth or mouth-to-nose resuscitation should be avoided when the smell of bitter almonds occurs, as the helper can put himself in a life-threatening danger of transmitted cyanide poisoning.

The application of oxygen is particularly indicated for patients who continue to have symptoms in the fresh air . In the case of unconscious patients, the emergency doctor should give hydroxycobalamin as a cyanide antidote in addition to the basic measures. An endotracheal intubation and a subsequent, controlled ventilation with 100 percent oxygen (FiO ₂ 1.0) is desirable. Seizures can be treated with benzodiazepines such as midazolam. Unconscious patients who are not found asystole seem to benefit from hyperbaric oxygenation (HBO; also hyperbaric oxygen therapy) in a pressure chamber within six hours.

Although the use of hydroxycobalamin is still controversial and has not been reliably proven in studies, both the animal experiments and - in the absence of side effects - the risk-benefit ratio speak in favor of the use of the antidote, especially since other cyanide antidotes such as 4-DMAP are or are contraindicated act too slowly, like sodium thiosulphate , which acts as a sulfur donor and supports the natural breakdown of cyanide.

The early administration of cortisone-containing metered dose inhalers with anti-inflammatory, anti- edematous and alveolar membrane stabilizing effects to prevent toxic pulmonary edema is no longer recommended due to a lack of data. For treatment of bronchospasm are β ₂ -sympathomimetics used.

Web links

• At the grave of three children who suffocated in the coal vapor (funeral song by Pastor Michael von Jung , 1839)

Individual evidence

1. ↑ ^{a b} Smoke alarms save lives. (No longer available online.) General Association of the German Insurance Industry (GDV), archived from the original on June 1, 2012 ; Retrieved March 8, 2005 . 
2. ↑ ^{a b c d} T. Zilker et al.: Smoke inhalation intoxication. In: The emergency doctor. 2010; 26, pp. 95-102.
3. ↑ Industrial Gas Association : Physiological dangers from carbon dioxide (CO ₂ ) - "Not just suffocating"
4. ↑ Peter Basmer: Measurement of poison gas cocktails in fires. ( Memento from January 3, 2014 in the Internet Archive )
5. ↑ Framework recommendation for operations in the event of a suspected CO emergency within premises. (pdf) German Fire Brigade Association , March 15, 2012, accessed on April 1, 2020 . 
6. ↑ International Program For Chemical Safety, WHO, Carbon Monoxide, 2004. Quoted from [1]
7. ↑ Myers et al: Value of hyperbaric oxygen in suspected carbon monoxide poisoning. In: JAMA. 1981; 246, pp. 2478-2480.
8. ↑ Ziser et al .: Delayed hyperbaric oxygen treatment for acute carbon monoxide poisoning. In: Br Med J. 1984; 289, p. 960.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !