A firefighter is rescued from a house fire with facial burns, singed nasal hairs, carbonaceous sputum, hoarseness, and confusion. Carboxyhaemoglobin level is 28%. Which intervention takes priority alongside airway assessment?

• A Nebulised salbutamol and corticosteroids
• B Prophylactic antibiotics covering upper respiratory flora
• C Hyperbaric oxygen therapy before any other measure
• D 100% oxygen by non-rebreathing mask ✓

Explanation

The features indicate inhalational injury with carbon monoxide poisoning. Carbon monoxide binds haemoglobin with affinity about 200 times that of oxygen, and 100% oxygen reduces its half-life from roughly 4 hours on room air to under an hour, making it the immediate priority. Hyperbaric oxygen is not the initial emergency step and is impractical in an unstable polytrauma patient. Steroids and antibiotics have no role prophylactically.

Reference: ATLS Advanced Trauma Life Support Student Course Manual, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.