Symptomdx.

Get Started

Smoke Exposure and Inhalational InjuryAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

538 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Wheezing, Undifferentiated Wheezing In Infants Stridor And Upper Airway Symptoms Dyspnea Aspiration Event Cough Hemoptysis Upper Respiratory Infection Symptoms Suspected Pulmonary Embolism Presentation Smoke Inhalation Concern Smoke Exposure And Inhalational Injury

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx66

Presenting symptoms

›Symptom profile

›Dyspnea

›Cough

›Chest tightness

›Wheeze

›Sooty sputum

›Voice change

›Throat pain

›Dysphagia

›Headache

›Nausea

›Confusion

Exposure details

›Smoke and inhalation exposure characterization

›Time since exposure

›Duration of exposure

›Enclosed space exposure

›Sleep or intoxication during exposure

›Source material

›House fire

›Wildfire

›Industrial

›Vehicle exhaust

›Chemical

›Steam

›Thermal

›Explosion

02Alarm Features/alarm36

Immediate escalation triggers

›Airway and breathing threats

›Stridor

›Respiratory fatigue

›Altered mental status with hypoventilation

›Silent chest

›Refractory hypoxemia on high flow oxygen

›Inability to handle secretions

›Progressive hoarseness

›Oropharyngeal edema

High risk exposure features

›Toxic inhalation concern

›Enclosed space fire

›Prolonged exposure

›Multiple victims

›Collapse at scene

›Soot in nares or oropharynx

›Carbon monoxide exposure concern

›Cyanide exposure concern

Vital sign danger thresholds

›Physiologic instability

›SpO2 less than 90 percent after oxygen

›RR greater than 30 per minute with work of breathing

›SBP less than 90 mmHg

›HR greater than 130 per minute with distress

›Temperature greater than 38.5 C with sepsis concern

High risk exam findings

›Airway burn and inhalation injury signs

03Medications/meds31

Current medications relevant to airway and cardiopulmonary status

›Medication reconciliation focus

›Inhaled bronchodilators

›Inhaled corticosteroids

›Systemic corticosteroids

›Home oxygen

›Opioids

›Sedatives

›Beta blockers

›Anticoagulants

Antidotes and ED therapies

›Acute medications and contraindications

›Albuterol inhaled

›Adult nebulized 2.5 mg to 5 mg

›Repeat every 20 minutes times 3 for severe bronchospasm

›Continuous nebulization protocol dependent

›Ipratropium inhaled

›Adult nebulized 0.5 mg

›Repeat every 20 minutes times 3 with albuterol for severe bronchospasm

›Dexamethasone

›Adult 10 mg IV once for significant airway edema concern

›Evidence for routine use in inhalation injury limited

›Hydroxocobalamin

›Adult 5 g IV over 15 minutes

›Repeat 5 g once if persistent shock or arrest

›Interference with some lab assays

›Nebulized heparin based protocol

›Local protocol dependent

04Diet/diet9

Recent intake and hydration

›Intake context

›Last oral intake timing

›Vomiting episodes

›Hydration status

Relevant exposures

›Ingestion and co exposure considerations

›Alcohol co ingestion

›Stimulants

›Illicit substances

›Smoke inhalation with possible CO exposure

05Review of Systems/ros27

Respiratory

›Respiratory symptoms

›Dyspnea

›Cough

›Wheeze

›Sputum

›Hemoptysis

›Pleuritic pain

ENT and airway

›Upper airway symptoms

›Hoarseness

›Sore throat

›Dysphagia

›Drooling

›Stridor

Neurologic and toxic

›Neuro toxic symptoms

›Headache

›Dizziness

›Confusion

›Syncope

›Seizure

Cardiac

›Cardiac symptoms

›Chest pain

›Palpitations

›Exertional intolerance

06Collateral History and Family History/chafh9

Collateral sources

›Scene and witness information

›EMS report

›Fire department report

›Family or bystander report

›Reliability of history

Family history

›Relevant inherited risks

›Early coronary disease

›Malignant hyperthermia history

›G6PD deficiency history

07Risk Factors/rf19

Patient factors

›Host risk factors for decompensation

›Age greater than 65 years

›Pregnancy

›COPD (J44.9)

›Asthma (J45.909)

›Heart failure (I50.9)

›Coronary disease (I25.10)

›Immunocompromise

Exposure risks

›Higher toxicity and airway risk

›Enclosed space fire

›Synthetic materials combustion

›Prolonged smoke exposure

›Delayed escape

›Loss of consciousness

Procedure and device risks

›Airway management complexity

›Known difficult airway

›Obesity

›OSA

›Prior head and neck radiation

08Differential Diagnosis/ddx51

Life threatening

›Life threatening causes

›Upper airway obstruction (J98.8)

›Hoarseness progression

›Stridor

›Oropharyngeal edema

›Carbon monoxide poisoning (T58)

›Headache

›Syncope

›Normal SpO2 on pulse oximetry

›Cyanide poisoning (T65.0)

›Enclosed space fire

›Severe lactic acidosis

›Shock

›Arrest

›Acute respiratory failure (J96.0)

›Hypoxemia

›Hypercapnia

›Fatigue

›ARDS (J80)

›Worsening oxygenation over hours

›Bilateral infiltrates

›Thermal airway injury (T27.3)

›Facial burns

›Singed hair

›Carbonaceous sputum

Common

›Common causes

09Past Medical History/pmh17

Chronic disease and baseline function

›Relevant conditions

›Asthma (J45.909)

›Prior ICU admissions

›Prior intubation

›COPD (J44.9)

›Home oxygen

›Baseline SpO2

›Coronary disease (I25.10)

›Prior MI

›Stents

›Heart failure (I50.9)

›Baseline volume status

›Recent diuretic changes

Prior procedures

›Prior airway and lung procedures

›Tracheostomy history

›Prior bronchoscopy

›Prior thoracic surgery

10Physical Exam/exam36

General and vitals

›Appearance and perfusion

›Toxic appearance

›Work of breathing

›Ability to speak full sentences

›Mental status

›Odor of smoke

›Vital signs pattern

›Tachypnea

›Hypoxemia

›Fever

›Hypotension

Airway and ENT

›Upper airway findings

›Hoarseness

›Stridor

›Oropharyngeal soot

›Oral mucosal edema

›Burns to lips or tongue

›Carbonaceous secretions

Respiratory

›Lung exam

›Wheeze

›Crackles

›Decreased air entry

›Prolonged expiration

›Accessory muscle use

11Lab Studies/labs26

Core labs for inhalational injury and tox

›Initial laboratory set

›Venous blood gas

›pH

›pCO2 in mmHg

›Co oximetry

›Carboxyhemoglobin percent

›Methemoglobin percent

›Lactate in mmol/L

›Marked elevation supports cyanide concern in context

›CBC

›Leukocytosis and infection signal

›Hemoglobin baseline for oxygen delivery

›CMP

›Creatinine baseline for contrast planning

›Transaminase elevation from hypoxia or toxins

Poisoning specific interpretation

›Carbon monoxide testing pearls

›Pulse oximetry may be falsely normal

›Carboxyhemoglobin level correlation with severity imperfect

›Cyanide concern testing pearls

›Lactate greater than 10 mmol/L with enclosed space fire supports high risk

›Definitive cyanide level typically delayed

Infection and alternative etiologies

›Additional labs when indicated

›Troponin when chest pain or ischemia risk

›BNP when heart failure concern

›Blood cultures when sepsis concern

12Imaging/img23

Scoring Systems

›Burn and inhalation injury severity frameworks

›Abbreviated Burn Severity Index

›Uses age

›Total body surface area

›Inhalation injury presence

›Bronchoscopic inhalation injury grading

›Degree of airway erythema and edema

›Soot and ulceration

MRI

›MRI considerations

›Not first line for acute smoke inhalation

›Brain MRI when persistent neurologic deficits after CO exposure

›Contraindications screening

›CT chest indications

›Concern for alternative diagnosis

›PE protocol when PE suspicion

›Significant hypoxemia with unclear chest x ray

›CT chest cautions

›Contrast nephropathy risk factors

›Radiation risk

Ultrasound

›POCUS applications

›Lung ultrasound for B lines and consolidation

›Cardiac ultrasound for shock evaluation

›IVC assessment for volume status limitations

13Special Tests/spec14

Airway evaluation tools

›Airway and inhalation injury diagnostics

›Flexible nasolaryngoscopy

›Supraglottic edema assessment

›Vocal cord mobility

›Bronchoscopy

›Inhalation injury grading

›Soot and mucosal injury

›Peak flow when asthma phenotype and stable

›Baseline comparison

›Effort dependence limitation

Pulmonary function and oxygenation

›Oxygenation assessment

›Ambulatory oximetry

›Exercise provoked desaturation

›Reliability limited by ongoing CO exposure if not measured by co oximetry

14ECG/ecg12

Indications and high risk findings

›ECG indications

›Chest pain

›Syncope

›Hypotension

›Known coronary disease

›Significant CO exposure

›High risk patterns

›ST elevation

›ST depression

›New T wave inversion

›Ventricular arrhythmia

›QT prolongation

15Assessment/ax22

Working problem list

›Suspected smoke inhalation and inhalational injury (T27.3)

›Exposure history consistent

›Airway findings present or absent

›Oxygenation status and trajectory

›Carbon monoxide poisoning concern (T58)

›Enclosed space exposure

›Neuro symptoms

›Carboxyhemoglobin result

›Cyanide toxicity concern (T65.0)

›Enclosed space fire with synthetic materials

›Shock pattern

›Lactate elevation

Severity stratification

›Severity features

›Need for airway intervention

›Need for high flow oxygen or ventilation

›Hemodynamic instability

›Significant burns with inhalation injury

Diagnostic uncertainty and alternatives

›Alternate diagnoses to exclude

›Pneumonia

›PE

›ACS

›Heart failure

16Plan/plan74

Differential Management

›!Smoke Inhalation Injury→›!Carbon monoxide poisoning→›Cyanide Poisoning→

First 5 minutes

›Immediate stabilization workflow

›Resuscitation bay criteria

›Stridor

›Altered mental status

›SpO2 less than 90 percent on oxygen

›Hypotension

›Monitoring

›Continuous pulse oximetry

›Cardiac monitor

›Frequent vitals

›IV access

›Two large bore IV for unstable patients

›IO if no IV and crashing

›Oxygen

›100 percent oxygen via non rebreather initially for CO concern

›High flow nasal cannula for persistent hypoxemia when protecting airway

›Airway plan

›Early intubation for evolving upper airway edema

›Difficult airway backup

Airway and breathing management

›Airway strategy

›If stridor or progressive airway edema then intubation without delay

›Smaller endotracheal tube may be required with edema

17Disposition/dispo25

ICU criteria

›ICU level of care indications

›Intubation

›Noninvasive ventilation requirement

›High flow oxygen requirement with tenuous trajectory

›Hemodynamic instability or vasopressors

›Significant metabolic acidosis

›Concern for cyanide toxicity

Inpatient and observation

›Admission criteria

›Persistent hypoxemia after ED therapy

›Abnormal chest imaging with symptoms

›Significant bronchospasm requiring frequent bronchodilators

›Elevated troponin or ischemic ECG changes in CO exposure

›Observation pathway criteria

›Mild symptoms improving

›Normal mental status

›Stable vitals for several hours

›Reliable follow up and return ability

Discharge criteria

›Discharge requirements

›No stridor

›No progressive hoarseness

›SpO2 at baseline on room air or home oxygen

›Ambulatory oximetry without desaturation

›Symptom improvement after bronchodilators if used

›No concerning lab abnormalities

›Safe home environment

18Discharge Instructions/di23

Copy discharge instructions

›Summary

›You were seen for symptoms after breathing smoke

›Your breathing and oxygen level improved in the emergency department

›Medications

›Use your inhaler as prescribed if you have one

›If you were given an inhaler today follow the instructions on the label

›Activity

›Avoid smoke exposure

›Rest and drink fluids

›Follow up

›Primary care within 1 to 2 days

›Return earlier if symptoms worsen

›Return to emergency department now for any of the following

›Trouble breathing

›Noisy breathing

›Worsening hoarse voice

›Chest pain

›Fainting

›Confusion

›Severe headache

›Blue lips

›Vomiting that prevents fluids

›Fever with worsening cough

19References/r18

Guidelines and key sources

›American Burn Association

›Advanced Burn Life Support course materials and inhalation injury guidance

›Burn center referral criteria guidance

›ATLS

›Advanced Trauma Life Support

›Airway and inhalation injury principles

›Undersea and Hyperbaric Medical Society

›Hyperbaric oxygen indications for carbon monoxide poisoning

›Local protocol dependent thresholds

›CDC

›Carbon monoxide poisoning clinical guidance

›Prevention and exposure considerations

›Goldfrank

›Toxicologic Emergencies

›Cyanide poisoning recognition and hydroxocobalamin treatment

›European Resuscitation Council

›Toxic causes of cardiac arrest considerations

›Post resuscitation care considerations

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Smoke Exposure and Inhalational InjuryAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

538 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx66

Presenting symptoms

›Symptom profile

›Dyspnea

›Cough

›Chest tightness

›Wheeze

›Sooty sputum

›Voice change

›Throat pain

›Dysphagia

›Headache

›Nausea

›Confusion

Exposure details

›Smoke and inhalation exposure characterization

›Time since exposure

›Duration of exposure

›Enclosed space exposure

›Sleep or intoxication during exposure

›Source material

›House fire

›Wildfire

›Industrial

›Vehicle exhaust

›Chemical

›Steam

›Thermal

›Explosion

02Alarm Features/alarm36

Immediate escalation triggers

›Airway and breathing threats

›Stridor

›Respiratory fatigue

›Altered mental status with hypoventilation

›Silent chest

›Refractory hypoxemia on high flow oxygen

›Inability to handle secretions

›Progressive hoarseness

›Oropharyngeal edema

High risk exposure features

›Toxic inhalation concern

›Enclosed space fire

›Prolonged exposure

›Multiple victims

›Collapse at scene

›Soot in nares or oropharynx

›Carbon monoxide exposure concern

›Cyanide exposure concern

Vital sign danger thresholds

›Physiologic instability

›SpO2 less than 90 percent after oxygen

›RR greater than 30 per minute with work of breathing

›SBP less than 90 mmHg

›HR greater than 130 per minute with distress

›Temperature greater than 38.5 C with sepsis concern

High risk exam findings

›Airway burn and inhalation injury signs

03Medications/meds31

Current medications relevant to airway and cardiopulmonary status

›Medication reconciliation focus

›Inhaled bronchodilators

›Inhaled corticosteroids

›Systemic corticosteroids

›Home oxygen

›Opioids

›Sedatives

›Beta blockers

›Anticoagulants

Antidotes and ED therapies

›Acute medications and contraindications

›Albuterol inhaled

›Adult nebulized 2.5 mg to 5 mg

›Repeat every 20 minutes times 3 for severe bronchospasm

›Continuous nebulization protocol dependent

›Ipratropium inhaled

›Adult nebulized 0.5 mg

›Repeat every 20 minutes times 3 with albuterol for severe bronchospasm

›Dexamethasone

›Adult 10 mg IV once for significant airway edema concern

›Evidence for routine use in inhalation injury limited

›Hydroxocobalamin

›Adult 5 g IV over 15 minutes

›Repeat 5 g once if persistent shock or arrest

›Interference with some lab assays

›Nebulized heparin based protocol

›Local protocol dependent

04Diet/diet9

Recent intake and hydration

›Intake context

›Last oral intake timing

›Vomiting episodes

›Hydration status

Relevant exposures

›Ingestion and co exposure considerations

›Alcohol co ingestion

›Stimulants

›Illicit substances

›Smoke inhalation with possible CO exposure

05Review of Systems/ros27

Respiratory

›Respiratory symptoms

›Dyspnea

›Cough

›Wheeze

›Sputum

›Hemoptysis

›Pleuritic pain

ENT and airway

›Upper airway symptoms

›Hoarseness

›Sore throat

›Dysphagia

›Drooling

›Stridor

Neurologic and toxic

›Neuro toxic symptoms

›Headache

›Dizziness

›Confusion

›Syncope

›Seizure

Cardiac

›Cardiac symptoms

›Chest pain

›Palpitations

›Exertional intolerance

06Collateral History and Family History/chafh9

Collateral sources

›Scene and witness information

›EMS report

›Fire department report

›Family or bystander report

›Reliability of history

Family history

›Relevant inherited risks

›Early coronary disease

›Malignant hyperthermia history

›G6PD deficiency history

07Risk Factors/rf19

Patient factors

›Host risk factors for decompensation

›Age greater than 65 years

›Pregnancy

›COPD (J44.9)

›Asthma (J45.909)

›Heart failure (I50.9)

›Coronary disease (I25.10)

›Immunocompromise

Exposure risks

›Higher toxicity and airway risk

›Enclosed space fire

›Synthetic materials combustion

›Prolonged smoke exposure

›Delayed escape

›Loss of consciousness

Procedure and device risks

›Airway management complexity

›Known difficult airway

›Obesity

›OSA

›Prior head and neck radiation

08Differential Diagnosis/ddx51

Life threatening

›Life threatening causes

›Upper airway obstruction (J98.8)

›Hoarseness progression

›Stridor

›Oropharyngeal edema

›Carbon monoxide poisoning (T58)

›Headache

›Syncope

›Normal SpO2 on pulse oximetry

›Cyanide poisoning (T65.0)

›Enclosed space fire

›Severe lactic acidosis

›Shock

›Arrest

›Acute respiratory failure (J96.0)

›Hypoxemia

›Hypercapnia

›Fatigue

›ARDS (J80)

›Worsening oxygenation over hours

›Bilateral infiltrates

›Thermal airway injury (T27.3)

›Facial burns

›Singed hair

›Carbonaceous sputum

Common

›Common causes

09Past Medical History/pmh17

Chronic disease and baseline function

›Relevant conditions

›Asthma (J45.909)

›Prior ICU admissions

›Prior intubation

›COPD (J44.9)

›Home oxygen

›Baseline SpO2

›Coronary disease (I25.10)

›Prior MI

›Stents

›Heart failure (I50.9)

›Baseline volume status

›Recent diuretic changes

Prior procedures

›Prior airway and lung procedures

›Tracheostomy history

›Prior bronchoscopy

›Prior thoracic surgery

10Physical Exam/exam36

General and vitals

›Appearance and perfusion

›Toxic appearance

›Work of breathing

›Ability to speak full sentences

›Mental status

›Odor of smoke

›Vital signs pattern

›Tachypnea

›Hypoxemia

›Fever

›Hypotension

Airway and ENT

›Upper airway findings

›Hoarseness

›Stridor

›Oropharyngeal soot

›Oral mucosal edema

›Burns to lips or tongue

›Carbonaceous secretions

Respiratory

›Lung exam

›Wheeze

›Crackles

›Decreased air entry

›Prolonged expiration

›Accessory muscle use

11Lab Studies/labs26

Core labs for inhalational injury and tox

›Initial laboratory set

›Venous blood gas

›pH

›pCO2 in mmHg

›Co oximetry

›Carboxyhemoglobin percent

›Methemoglobin percent

›Lactate in mmol/L

›Marked elevation supports cyanide concern in context

›CBC

›Leukocytosis and infection signal

›Hemoglobin baseline for oxygen delivery

›CMP

›Creatinine baseline for contrast planning

›Transaminase elevation from hypoxia or toxins

Poisoning specific interpretation

›Carbon monoxide testing pearls

›Pulse oximetry may be falsely normal

›Carboxyhemoglobin level correlation with severity imperfect

›Cyanide concern testing pearls

›Lactate greater than 10 mmol/L with enclosed space fire supports high risk

›Definitive cyanide level typically delayed

Infection and alternative etiologies

›Additional labs when indicated

›Troponin when chest pain or ischemia risk

›BNP when heart failure concern

›Blood cultures when sepsis concern

12Imaging/img23

Scoring Systems

›Burn and inhalation injury severity frameworks

›Abbreviated Burn Severity Index

›Uses age

›Total body surface area

›Inhalation injury presence

›Bronchoscopic inhalation injury grading

›Degree of airway erythema and edema

›Soot and ulceration

MRI

›MRI considerations

›Not first line for acute smoke inhalation

›Brain MRI when persistent neurologic deficits after CO exposure

›Contraindications screening

›CT chest indications

›Concern for alternative diagnosis

›PE protocol when PE suspicion

›Significant hypoxemia with unclear chest x ray

›CT chest cautions

›Contrast nephropathy risk factors

›Radiation risk

Ultrasound

›POCUS applications

›Lung ultrasound for B lines and consolidation

›Cardiac ultrasound for shock evaluation

›IVC assessment for volume status limitations

13Special Tests/spec14

Airway evaluation tools

›Airway and inhalation injury diagnostics

›Flexible nasolaryngoscopy

›Supraglottic edema assessment

›Vocal cord mobility

›Bronchoscopy

›Inhalation injury grading

›Soot and mucosal injury

›Peak flow when asthma phenotype and stable

›Baseline comparison

›Effort dependence limitation

Pulmonary function and oxygenation

›Oxygenation assessment

›Ambulatory oximetry

›Exercise provoked desaturation

›Reliability limited by ongoing CO exposure if not measured by co oximetry

14ECG/ecg12

Indications and high risk findings

›ECG indications

›Chest pain

›Syncope

›Hypotension

›Known coronary disease

›Significant CO exposure

›High risk patterns

›ST elevation

›ST depression

›New T wave inversion

›Ventricular arrhythmia

›QT prolongation

15Assessment/ax22

Working problem list

›Suspected smoke inhalation and inhalational injury (T27.3)

›Exposure history consistent

›Airway findings present or absent

›Oxygenation status and trajectory

›Carbon monoxide poisoning concern (T58)

›Enclosed space exposure

›Neuro symptoms

›Carboxyhemoglobin result

›Cyanide toxicity concern (T65.0)

›Enclosed space fire with synthetic materials

›Shock pattern

›Lactate elevation

Severity stratification

›Severity features

›Need for airway intervention

›Need for high flow oxygen or ventilation

›Hemodynamic instability

›Significant burns with inhalation injury

Diagnostic uncertainty and alternatives

›Alternate diagnoses to exclude

›Pneumonia

›PE

›ACS

›Heart failure

16Plan/plan74

Differential Management

›!Smoke Inhalation Injury→›!Carbon monoxide poisoning→›Cyanide Poisoning→

First 5 minutes

›Immediate stabilization workflow

›Resuscitation bay criteria

›Stridor

›Altered mental status

›SpO2 less than 90 percent on oxygen

›Hypotension

›Monitoring

›Continuous pulse oximetry

›Cardiac monitor

›Frequent vitals

›IV access

›Two large bore IV for unstable patients

›IO if no IV and crashing

›Oxygen

›100 percent oxygen via non rebreather initially for CO concern

›High flow nasal cannula for persistent hypoxemia when protecting airway

›Airway plan

›Early intubation for evolving upper airway edema

›Difficult airway backup

Airway and breathing management

›Airway strategy

›If stridor or progressive airway edema then intubation without delay

›Smaller endotracheal tube may be required with edema

17Disposition/dispo25

ICU criteria

›ICU level of care indications

›Intubation

›Noninvasive ventilation requirement

›High flow oxygen requirement with tenuous trajectory

›Hemodynamic instability or vasopressors

›Significant metabolic acidosis

›Concern for cyanide toxicity

Inpatient and observation

›Admission criteria

›Persistent hypoxemia after ED therapy

›Abnormal chest imaging with symptoms

›Significant bronchospasm requiring frequent bronchodilators

›Elevated troponin or ischemic ECG changes in CO exposure

›Observation pathway criteria

›Mild symptoms improving

›Normal mental status

›Stable vitals for several hours

›Reliable follow up and return ability

Discharge criteria

›Discharge requirements

›No stridor

›No progressive hoarseness

›SpO2 at baseline on room air or home oxygen

›Ambulatory oximetry without desaturation

›Symptom improvement after bronchodilators if used

›No concerning lab abnormalities

›Safe home environment

18Discharge Instructions/di23

Copy discharge instructions

›Summary

›You were seen for symptoms after breathing smoke

›Your breathing and oxygen level improved in the emergency department

›Medications

›Use your inhaler as prescribed if you have one

›If you were given an inhaler today follow the instructions on the label

›Activity

›Avoid smoke exposure

›Rest and drink fluids

›Follow up

›Primary care within 1 to 2 days

›Return earlier if symptoms worsen

›Return to emergency department now for any of the following

›Trouble breathing

›Noisy breathing

›Worsening hoarse voice

›Chest pain

›Fainting

›Confusion

›Severe headache

›Blue lips

›Vomiting that prevents fluids

›Fever with worsening cough

19References/r18

Guidelines and key sources

›American Burn Association

›Advanced Burn Life Support course materials and inhalation injury guidance

›Burn center referral criteria guidance

›ATLS

›Advanced Trauma Life Support

›Airway and inhalation injury principles

›Undersea and Hyperbaric Medical Society

›Hyperbaric oxygen indications for carbon monoxide poisoning

›Local protocol dependent thresholds

›CDC

›Carbon monoxide poisoning clinical guidance

›Prevention and exposure considerations

›Goldfrank

›Toxicologic Emergencies

›Cyanide poisoning recognition and hydroxocobalamin treatment

›European Resuscitation Council

›Toxic causes of cardiac arrest considerations

›Post resuscitation care considerations

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.