Pediatric Smoke Inhalation Injury

San Mateo County Emergency Medical Services Pediatric Smoke Inhalation Injury For patients with smoke inhalation History Signs and Symptoms Differential • Number and severity of other victims • Facial burns, pain, and/or swelling • Foreign Body Aspiration • Industrial or residential fire • Cherry red skin • Asthma exacerbation • Duration of inhalation • Loss of consciousness • Cyanide poisoning • Social history - smoking • Hypotension/shock • Carbon monoxide poisoning • Past medical history • Airway compromise/distress could be indicated by • Thermal injury • Other trauma hoarseness/wheezing • Heart failure • Odor • Seizure/AMS after industrial or closed space fire • Acute respiratory distress syndrome consider cyanide poisoning

Scene safety. Quantify and Approved triage patients. Load and go Burn Receiving Centers with assessment and treatment Assess enroute to hospital St. Francis – San Francisco Airway Valley Med. Center – San Jose UC Davis – Sacramento

No or Mild Airway Involvement Moderate Airway Involvement Severe Airway Involvement Airway patent, no signs of edema, no Suspected inhalation injury with only one Accessory muscle use or altered breath stridor or change in voice, nasal hairs of the following: Wheezing, change in sounds intact, low likelihood of airway voice, increased work of breathing/ OR involvement tachypnea. Any combination of the following: Airway edema, stridor, change in voice, increased work of breathing/tachypnea.

If oxygen saturation ≥ 92% Monitor and reassess Routine Medical Care E Apply Oxygen to maintain goal Monitor and reassess SpO > 92% 2 E High flow Oxygen Cardiac monitor Regardless of SpO2 Cardiac monitor Consider, IV P Head Trauma Consider, Albuterol Consider, 12-Lead ECG Use Broselow Tape; refer to dosing guide Consider, IV/IO Pain Albuterol P Use Broselow Tape; refer to dosing guide Burns Notify receiving facility. Consider Base Hospital Epinephrine 1:1,000 nebulized for stridor for medical direction Carbon Monoxide/ Use Broselow Tape; refer to dosing guide Cyanide CPAP

Hazmat Closest receiving facility Hypotension for definitive airway. Consider Base Hospital for medical direction Eye Injury

Treatment Protocol PR07 Page 1 of 2 EffectiveEffective November August 2018 2020 San Mateo County Emergency Medical Services Pediatric Smoke Inhalation Injury For patients with smoke inhalation

Pearls • Ensure patient is properly decontaminated before placing in ambulance and transport to hospital. • Contact Hazmat or Poison Control Center with questions about chemical or guidance on immediate treatment. • If able, obtain the name of chemical(s) patient was exposed to pass information along to receiving hospital staff. • If able, remove patient’s clothing before placing in ambulance and transport to hospital. Treatment Protocol PR07 Page 2 of 2 EffectiveEffective November August 2018 2020