Strong indication for pregnancy, severe neurologic symptoms, cardiac ischemia
Practical limitation — most centers lack 24-hour HBO2 access
Early vs. delayed intubation
Sheridan (NEJM 2016): inhalation injury does not mandate intubation
Airway patency not threatened and <20% TBSA burns: supportive care acceptable
Head-of-bed elevation and humidified air for non-intubated patients
Inhaled nitric oxide
Under investigation for reducing pulmonary hypertension in ARDS from inhalation injury
Not standard of care; specialized center use only
Patient Discharge Instructions
copy discharge instructions
What happened to you
You were exposed to smoke, which contains carbon monoxide and other toxic gases
Carbon monoxide can linger in your blood for hours after leaving the fire
Symptoms may develop or worsen over the next 24-48 hours
Your lungs and airway may be irritated even if you feel better now
Swelling and injury can develop slowly after smoke exposure
A follow-up appointment within 24-48 hours is required
Return to emergency immediately if you develop
Worsening shortness of breath or difficulty breathing
Any new or worsening stridor (high-pitched breathing sound)
Coughing up blood
Chest pain or irregular heartbeat
Feeling faint or losing consciousness
Severe persistent headache not relieved by pain medication
Voice changes, increasing hoarseness, or difficulty swallowing
Throat tightness
Drooling or inability to handle secretions
Confusion, memory problems, or personality changes
These can be delayed symptoms of carbon monoxide poisoning
May develop days to weeks after exposure
Worsening cough or fever
Lung infection can develop in the days after smoke inhalation
Activity and home care instructions
Rest and avoid strenuous activity for 24-48 hours
Do not exercise until cleared by follow-up physician
Avoid smoke and air pollutants
Do not use a gas stove, fireplace, or gas heater until inspected
Install or check carbon monoxide detectors in your home
Ensure detectors have working batteries
Drink plenty of fluids unless instructed otherwise
Stay hydrated to help clear secretions
Follow up with your doctor or walk-in clinic within 24-48 hours
Bring a list of all medications given in the emergency department
Report any new neurologic symptoms at follow-up
References
Guidelines and key sources
Sheridan RL. Fire-Related Inhalation Injury. N Engl J Med. 2016
Foundational review on management algorithm and indications for intubation
Outlines three-component injury model
Greenhalgh DG. Management of Burns. N Engl J Med. 2019
Comprehensive review including inhalation injury epidemiology
Mortality data and burn center criteria
Enkhbaatar P, Pruitt BA, Suman O et al. Pathophysiology, Research Challenges, and Clinical Management of Smoke Inhalation Injury. Lancet. 2016
Pathophysiology of chemical tracheobronchitis and cast formation
Evidence for nebulized heparin/NAC regimen
Lavonas EJ et al. 2023 AHA Focused Update: Management of Cardiac Arrest or Life-Threatening Toxicity from Poisoning. Circulation. 2023
Hydroxocobalamin as preferred cyanide antidote in smoke inhalation
Avoidance of sodium nitrite in combined CO/cyanide poisoning
Cao D et al. Part 10: Adult and Pediatric Special Circumstances. 2025 AHA CPR Guidelines. Circulation. 2025
Updated guidance for smoke inhalation cardiac arrest
Affirms empirical hydroxocobalamin use
Deutsch CJ, Tan A, Smailes S, Dziewulski P. Diagnosis and Management of Inhalation Injury: An Evidence Based Approach. Burns. 2018
Systematic review of nebulized therapies and airway management
Evidence levels for treatment interventions
Amarasekera NN et al. Evaluating Bronchoscopic Severity of Burns-Related Smoke Inhalation Injury and Clinical Outcomes. Burns. 2025
Systematic review and meta-analysis of bronchoscopic grading
Higher grade associated with increased ARDS and mortality
Culnan DM et al. Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient. Ann Plast Surg. 2018
Pregnancy-specific HBO2 indications
Fetal hemoglobin CO binding avidity data
Foncerrada G, Culnan DM et al. Inhalation Injury in the Burned Patient. Ann Plast Surg. 2018
Pathophysiology of airway injury and cast formation
Role of bronchoscopy in diagnosis and management
Snodgrass K et al. Impact of Protocol Development on Hydroxocobalamin Use. J Burn Care Res. 2026
Pre-post analysis of hydroxocobalamin protocol for cyanide poisoning
Supports empirical use in at-risk smoke inhalation patients
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.