Medical

Carbon monoxide / cyanide smoke exposure

Before / During / After / Pitfalls

Before

• High-flow oxygen immediately; pulse oximetry may be misleading in CO exposure.
• Evaluate for inhalation injury, burns, soot, hoarseness, altered mental status, severe lactic acidosis.
• Consider cyanide/CO treatment pathways per local protocol and early burn/toxicology resources.

During

• If intubating, anticipate airway edema and smaller tube needs.
• Avoid delaying toxic inhalation treatment while focusing on the tube.
• Secure tube carefully if facial burns are present.

After

• Continue CO/cyanide pathway, burn/ICU consultation, and ventilator reassessment.
• Serial lactate, ABG/co-oximetry as available, neuro/cardiac monitoring.
• Plan for evolving edema.

Pitfalls

• Relying on standard pulse oximetry to exclude CO.
• Missing cyanide physiology in enclosed-space fire with shock/lactate.
• Poor tube securement on burned tissue.