Inhaling smoke causes smoke inhalation: put that in your hookah pipe!

Emergency physicians need no reminders to be vigilant for accidental carbon monoxide poisoning. Because its earliest symptoms are vague and mimic a viral illness, carbon monoxide has been coined “the great masquerader.” Missing the diagnosis risks continued exposure in patients discharged back to the same environment and represents a lost opportunity to identify other victims. In this issue, La Fauci and colleagues warn us about an unusual cause of carbon monoxide poisoning: smoking a narghile, commonly known as a water pipe or hookah.1 Case reports are valuable not just for cautioning us, as so many do, to “be aware” but also when they identify the leading edge of something big. And hookah smoking is becoming increasingly popular in Canada, with a self-reported past-year prevalence of about one-quarter of young adults in a recent survey.2