During fires, the effects of heat and noxious effluents are cumulative in caus ing injury to the victims. Carbon monoxide (CO), which is invariably present as a toxic component of fire emissions, often acts synergistically with cyanide released by various materials. Clinical findings are variable, depending on the extent of external burns, upper airway and lung damage, and toxic exposure. Neuropsychiatric symptoms and respiratory distress are common manifesta tions. Life-threatening complications, such as pulmonary oedema, may sud denly develop up to several days after the smoke exposure. Therapeutic mea sures include general supportive care as well as the treatment of bums and associated systemic toxicity. Arterial blood gases, carboxyhaemoglobin and cyanide levels should be monitored. Patients exposed to significant concentra tions of CO require hyperbaric oxygen therapy. Suspected cyanide poisoning must be treated without the waiting for laboratory confirmation. Untimely or incorrect intervention may compromise the chances of survival and seriously affect the future health status of fire victims.
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