Discharge Instructions for 18-Year-Old Male After Bonfire Smoke Inhalation
For an 18-year-old male with improved chest pain after bonfire smoke inhalation and a HEART score of 0, discharge instructions should include education about warning signs requiring urgent evaluation, home care recommendations, and follow-up guidance.
Assessment of Low Risk Status
This patient can be safely discharged based on:
- Age <40 years with non-classical presentation (smoke inhalation as clear trigger)
- Lack of significant cardiac history
- HEART score of 0 (indicating <1% risk of major adverse cardiac events)
- Improvement of symptoms during observation
- Normal ECG and cardiac biomarkers (implied by HEART score of 0)
Discharge Instructions
Symptom Monitoring
- Monitor for worsening respiratory symptoms including:
- Increased shortness of breath
- Worsening chest pain
- Coughing, especially with sputum production
- Wheezing or difficulty breathing
- Fever development
When to Seek Emergency Care
- Return to the emergency department immediately if:
- Chest pain returns and is severe, prolonged (>5 minutes), or associated with shortness of breath, nausea, or sweating 1
- Difficulty breathing develops or worsens
- Symptoms are unimproved or worsening after taking any prescribed medications
- Fever >101°F (38.3°C) develops
Medication Instructions
- Take over-the-counter pain relievers as needed for mild chest discomfort:
- Acetaminophen (Tylenol) 650 mg every 6 hours as needed
- Avoid NSAIDs if there's concern about respiratory inflammation
- Complete any prescribed medications (if applicable)
Activity Recommendations
- Rest for 24-48 hours
- Gradually return to normal activities as tolerated
- Avoid strenuous physical activity for at least 3-5 days
- Avoid exposure to smoke, dust, or other respiratory irritants
Hydration and Nutrition
- Maintain good hydration (8-10 glasses of water daily)
- Avoid alcohol and smoking which can irritate the airways
Follow-up Care
- Follow up with primary care provider within 1 week 1
- No need for routine chest X-ray follow-up unless symptoms worsen or fail to resolve 1
Prevention of Future Episodes
- Avoid direct exposure to smoke from bonfires, campfires, or other burning materials
- If exposure is unavoidable, maintain greater distance from the fire
- Consider using a mask if in smoky environments
Special Considerations
- Patients with fleeting chest pain that has completely resolved and no concerning features can be safely discharged with appropriate follow-up 2, 3
- Young patients without history of previous ischemic heart disease, with atypical presentations and negative cardiac workup have very low short-term risk of adverse events 1
This patient's presentation is consistent with irritation of the respiratory tract from smoke inhalation rather than acute coronary syndrome, and with a HEART score of 0, he is at very low risk for cardiac events, making discharge with these instructions appropriate.