David Bird examines key issues for emergency nurses caring for patients with inhalation injuries

As last month’s train crash at Paddington tragically underlined, smoke inhalation and skin loss are the two potentially catastrophic injuries that can occur from exposure to fire. Each is a severe injury but in combination mortality increases significantly (Carrougher 1993). Epidemiological studies in the UK estimate that death from smoke inhalation varies from between 45 per cent - 90 per cent of those who are admitted to hospital (Boswell 1997). In view of its complex pathology and poor outcome, A&E personnel must be vigilant to its presence and ensure subsequent management is both prompt and appropriate. This article will present the pathophysiology of smoke inhalation injuries, the presenting symptomology and the expected nursing response.