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Doctors: Smoke Inhalation Victim Can Seem Fine, Go Into Lung Failure Suddenly
When some crewmen of the HMCS Chicoutimi were caught in two flash fires Tuesday morning, they likely inhaled smoke containing hundreds of toxic chemicals that may have severely injured their lungs.
But the most dangerous damage isn't caused by those chemicals, it's the inflammation that arises after special immune-system cells rush to the site to mop up the damage left by the chemical assault, doctors say.
``There is damage to those delicate breathing sacs in the lung and the damage actually grows worse over those next 24 to 36 hours,'' Dr. Kenneth Chapman, director of the Asthma and Airway Centre at Toronto's University Health Network, said Thursday.
That's why smoke inhalation can be so tricky: a chest X-ray can look clear and oxygen levels in the blood may appear normal in the first hours after a fire. But a day or more later, the victim can suddenly take a turn for the worse as the lungs become soggy and stiff.
``They can't exchange oxygen properly and if you do a chest X-ray at that point, you may actually see evidence of damage that you didn't see two days ago when the injury was first sustained,'' said Dr. Robert Cartotto, a burn surgeon at Sunnybrook and Women's Health Sciences Centre in Toronto.
A smoke-inhalation patient brought to hospital emergency may be admitted for observation and oxygen treatment, especially if the injury appears to be severe. That way, doctors can quickly put the patient in intensive care and hook them up to a breathing machine, or ventilator, if respiratory failure looks imminent.
While the cause of Lieut. Chris Saunders' death Wednesday afternoon hasn't been officially determined, Cartotto said it ``looks like the typical pattern of an inhalation injury where the delayed effects become profound within a few days' time.''
``Inhalation injury is one of the things we always worry about, and it's the great masquerader,'' he said. ``You just never know which ones are going to get bad. And when it gets bad, it gets bad quickly. They can seem to be fine and have a little bit of a cough, and then they can just get into severe failure.
``It literally can happen in a matter of a few hours.''
Citing figures from a U.S. study, Chapman said 75 per cent of fire deaths result from smoke inhalation, not burns or other heat-related injuries.
Did the delay in airlifting Saunders to hospital contribute to his death?
While it's not known what kind of medical equipment was on board the Chicoutimi, Chapman said there's little that can be done for smoke inhalation in the first 24 hours besides providing oxygen and perhaps giving intravenous fluids.
``The big intervention, the thing we think of with intensive-care units, would be the ventilators,'' a kind of high-tech care that would be difficult in the close quarters of a submarine, especially one without engine power being tossed about by the wind-whipped waters of the North Atlantic.
``So the question is, did the support get there too late? Would the outcome have been different if they'd been sitting in a hospital. I don't know.''
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