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Carbon monoxide inhalation injury — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsCarbon monoxide inhalation injurySCE Acute Medicine

A 69-year-old woman presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show normal pulse oximetry despite raised carboxyhaemoglobin and acidosis. What is the most appropriate next step in management?

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Correct answer: B — Give high-flow oxygen and assess need for hyperbaric oxygen referral

The key discriminator is that normal pulse oximetry despite raised carboxyhaemoglobin and acidosis, which makes Give high-flow oxygen and assess need for hyperbaric oxygen referral the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Optimise chronic medication and discharge are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; Resuscitation Council UK