CO poisoning and smoke inhalation injury

It is now a well-known fact that a majority of deaths occurring in fires are not due to burns but due to asphyxia68. Smoke is a complex mixture of burning substances but nearly always includes CO and cyanide69.

Beyond airway injuries (burns, obstruction by dust, necrotic debris, etc), CO poisoning must always be suspected in these patients, all the more if patients have lost consciousness or where neurological anomalies are observed. Metabolic acidosis should also lead clinicians to suspect CO

poisoning .

Determining CO concentration in expired air in conscious patients enables selection of those requiring oxygen therapy.

If HBO is indicated, the pulmonary status should always be evaluated relative to the neurological risks of non treatment. Risk-benefit decisions should then be made.

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