Fumes in industrial fires can make inhalation injury more severe—a report of three cases of industrial burn accidents

Abstract

The pattern of burns in industrial accidents often involves the face, since it is unprotected by work gear. A facial burn raises the question on inhalation injury. Diagnosis is based on clinical examination on admission, circumstances of the injury, fiberoptic bronchoscopy and clinical course [1,2], since there is no laboratory value to establish inhalation injury [3]. In the initial setting, however, these indicators can be unreliable and basing the diagnosis solely on the accompanying circumstances can be misleading. There are two mechanisms in inhalation injury, heat damage and fume damage to the epithelium. The latter is thought to be the more severe [4]. Toxic fumes set free by the fire can inflict severe damage to the lung epithelium without soot deposition. If initial diagnosis is based on the findings in the upper trachea during bronchoscopy, inhalation injury is easily overlooked or underestimated. This can lead to serious consequences since the injury severely impairs lung function and late onset of treatment worsens the clinical course [5]. The effects and long-term sequelae of chronic exposure to toxic fumes in the industrial setting are well investigated [6– 8]. Less is known about the effects of acute exposure. In most cases a single toxic agent cannot be identified [9,10]. The pattern of injury is often direct inhalation of toxic fumes without accompanying burns. Single agents identified include hydrogen sulphide, anhydrous ammonia, formic acid, hydrofluoric acid, phosphor, bromine and aluminium [11– 19] but also pure steam [20]. A direct and quickly resolving response to the inhalation of heavy metals is known as metal fume fever (MFF). It presents with symptoms of cough, fever, chills, malaise and myalgia [21]. MFF can lead to long-term sequelae such as obstructive lung diseases [22–25].