TOXICOLOGY & ADDICTION MEDICINE
Beyond Oxygen: Evolving Management of Carbon Monoxide and Cyanide Poisoning By Jordan A. Woolum, PharmD and Peter Tran, PharmD
At a Glance
SAEM PULSE | MAY-JUNE 2026
• Why this matters now: Inhalational injuries from fires continue to drive preventable morbidity and mortality, with carbon monoxide and cyanide acting as key, often underrecognized contributors.
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• What you’ll learn: A clinically focused update on evolving management strategies, including hyperbaric oxygen controversies, adjunctive therapies, and emerging antidotes for cyanide toxicity. • Who this is for: Emergency physicians, trainees, and pharmacists managing toxicologic and inhalational exposures in acute care settings.
Introduction
Inhalational injuries from fire-related events resulted in an estimated 3,800 deaths in 2021, equating to one death every two hours and 17 minutes. These injuries and fatalities result from a complex mixture of heated air, particles, and chemicals, the composition of which depends on the source of the fire and fumes. General care strategies for patients with inhalational injury include standard supportive measures such as removal from the source, external decontamination, and administration of oxygen. Despite advancements in supportive care, significant morbidity and mortality persist,
likely attributable to the chemical asphyxiants carbon monoxide and cyanide. Although existing treatments improve outcomes, gaps remain. Here, we describe recent advancements in the management of these exposures, with a focus on novel therapeutic strategies.
Carbon Monoxide
Carbon monoxide (CO) is an odorless, colorless gas formed during the partial combustion of carbon-containing compounds. Acute fatalities from CO exposure are primarily due to a leftward shift in the oxygen-hemoglobin dissociation curve, which increases oxygen’s affinity for hemoglobin