Smoke Inhalation Administrative Guideline

Question 1

History

Answer 1

• Smoke Inhalation
• Time of injury
• Other trauma
• Airway/inhalation

Question 2

Signs and symptoms

Answer 2

• AMS
• Dyspnea
• Syncope
• Chest Pain
• Cardiac Arrest

Question 3

Differential

Answer 3

• MI
• Trauma/Head injury
• Other chemical exposure

Question 4

First step in treating a patient with smoke inhalation

Answer 4

Remove them from the smoke.

Duh.

Oh and look at code arrest or burn AGs too.

Question 5

Secondary steps in treating a patient with smoke inhalation

Answer 5

High flow O2 via NRB
IV/IO placement (avoid placement through burned skin)
Consider 2 IV sites for burns larger than 10%
Cardiac monitor, EtCO2 monitor if indicated
Consider CPAP for patients with signs or symptoms of smoke inhalation (see above)

Question 6

Symptoms of severe cyanide toxicity?

Answer 6

Hydroxocobalamin 70 mg/kg IV/IO
Max 5 g dose
May repeat x 1

Question 7

Where do you take them?

Answer 7

Transport to appropriate destination per SAEMS Regional Trauma Triage

Question 8

Symptoms of CN toxicity

Answer 8

• Altered LOC, unconsciousnes, or seizures
• Soot in the mouth or expectoration
• Cardiac arrest

Question 9

Side effects of hydroxocobalamin

Answer 9

red colouring of skin and urine, urticaria, rarely anaphylaxis. It may also cause tachycardia and hypertension

Question 10

Administration instructions for hydroxocobalamin

Answer 10

• Reconstitute: Place the vial in an upright position. Add 200 mL of 0.9% Sodium Chloride injection
  to the vial using the transfer spike. Fill to the line. (LR and dextrose are also compatible)
• Mix: The vial should be repeatedly inverted or rocked, not shaken, for at least 60 seconds prior to
  infusion.
• Infuse Vial: Use vented intravenous tubing, hang and infuse over 15 minutes. Will need to use
  push pull method if administering through an IO.

Question 11

What’s the pediatric starting dose for hydroxocobalamin?

Answer 11

70 mL/kg is the starting dose. May round up to the nearest 1/4 of a bottle.

Question 12

Can you use CPAP on smoke inhalation patients?

Answer 12

Only if they are breathing on their own.