Anaes · Plastics and burns anaesthesia
Inhalational injury, carbon monoxide, and cyanide in burns
Also known as Inhalational injury, carbon monoxide, and cyanide in burns · Smoke inhalation CO cyanide
Exam-exhaustive inhalational injury with CO and cyanide management for ANZCA Final: early intubation triggers, co-oximetry, CO half-life on oxygen, hydroxocobalamin 5 g IV, protective ventilation, and interaction with burn fluid resuscitation.
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Target exams
Red flags
- Early intubation for threatened smoke airway.
- SpO2 unreliable in CO — use co-oximetry.
- Hydroxocobalamin 5 g IV for suspected cyanide.
- 100% oxygen shortens CO half-life.
- Airway oedema progresses over hours.
Meet the patient
The ambulance hands over a house-fire victim pulled unconscious from an enclosed space. Clothes smell of smoke, soot rings the nostrils, and there are patchy facial burns. The finger-probe SpO2 reads 99 percent on oxygen. The trap is false reassurance — with no signature clinical symptom, diagnosis depends on injury history, carboxyhaemoglobin, and mental status, not the probe number.[5]
Smoke inhalation kills by progressive airway oedema, carbon monoxide, cyanide, chemical pneumonitis, and later pneumonia. The viva pivots are crisp: when to intubate, why the pulse oximeter lies in carbon monoxide, the exact half-life numbers, and hydroxocobalamin 5 g IV — the CO numbers owned by the intoxication review and the burned-pregnant review.[4][5]
References6ShowHide
- [1]Borron SW, Baud FJ, Barriot P, et al. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation Ann Emerg Med, 2007.PMID 17481777
- [2]Baxter CR Fluid volume and electrolyte changes of the early postburn period Clin Plast Surg, 1974.PMID 4609676
- [3]Martyn JA, Richtsfeld M Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms Anesthesiology, 2006.PMID 16394702
- [4]Bleecker ML Carbon monoxide intoxication. Handb Clin Neurol, 2015.PMID 26563790
- [5]Culnan DM, Craft-Coffman B, Bitz GH, et al. Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient: An Indication for Hyperbaric Oxygen Therapy. Ann Plast Surg, 2018.PMID 29461288
- [6]Virdis E, Fara G, Paliogiannis P, et al. The prognostic role of inhalation injury in burn patients assessed by flexible bronchoscopy: a systematic review and meta-analysis. Front Med (Lausanne), 2026.PMID 42292253