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Smoke inhalation injury — SCE Respiratory MCQ

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HardRare and miscellaneousSmoke inhalation injurySCE Respiratory

A 29-year-old man is rescued from a house fire and has soot around the mouth, hoarseness and confusion. SpO2 reads 99% on pulse oximetry while ABG co-oximetry shows carboxyhaemoglobin 28% and lactate 9 mmol/L. He is tachypnoeic and has singed nasal hairs. There are no cutaneous burns requiring fluid resuscitation. What is the most appropriate management?

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Correct answer: D — High-flow oxygen and urgent airway assessment for inhalational injury

Pulse oximetry is falsely reassuring in carbon monoxide poisoning, and hoarseness with soot suggests airway injury needing urgent assessment. High-flow oxygen accelerates carbon monoxide elimination while airway oedema can progress. Raised lactate should also raise concern for cyanide toxicity in significant smoke inhalation.

Reference: Resuscitation Council UK; BTS emergency oxygen guidance