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Case report
Toxic inhalational injury
  1. Victoria Davies1,
  2. Jake Turner2 and
  3. Michael Greenway2
  1. 1Medical School, Keele University, Keele, UK
  2. 2Department of Anaesthesia, Royal Stoke University Hospital, Stoke-on-Trent, UK
  1. Correspondence to Victoria Davies; w4h99{at}


A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.

  • antidotes
  • carbon monoxide
  • cyanides
  • hydroxocobalamin
  • pre-hospital
  • smoke
  • thiosulfates

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  • Twitter @toridavies93, @JakeTurner99, @mikegreenway

  • Contributors VD literature review, author of manuscript. JT review and editing of manuscript, identification of case and management of case. MG literature review, review of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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