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This 45-year-old back female was involved in a house fire which killed her husband. Upon admission to a local emergency room she was found to have The patient had approximately 80% body surface area burns including 1st, 2nd, and 3rd degree burns. Burns were most severe around the head and neck. The patient was intubated and transferred to a tertiary care center. Upon arrival, the patient had a blood pressure of 71/25 mmHg, a heart rate of 121, and was responsive to deep pain but had few spontaneous movements. Both eyes were swollen shut, her nasal hairs were singed, and carbonaceous deposits were present in her nares, throat, and posterior pharynx. Despite given aggressive fluid resuscitation and ventilatory support, but she remained hypotensive, and became progressively hypoxemic and hypercapnic until she died approximately eight hours after the fire.  Carbonaceous material was noted in the throat and posterior pharynx as well as in the trachea and main stem bronchi. The liver was soft, yellow and greasy. Results of premortem blood work showed an elevated blood alcohol level.