R07 Page 1 of 2 Effectiveeffective November October 2018 2019 San Mateo County Emergency Medical Services Smoke Inhalation Injury for Patients with Smoke Inhalation

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R07 Page 1 of 2 Effectiveeffective November October 2018 2019 San Mateo County Emergency Medical Services Smoke Inhalation Injury for Patients with Smoke Inhalation

San Mateo County Emergency Medical Services 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 • COPD exacerbation • Social history - smoking • Hypotension/shock • Cyanide poisoning • Past medical history • Airway compromise/distress could be indicated by • Carbon monoxide poisoning • Other trauma hoarseness/wheezing • Thermal injury • Odor • Seizure/AMS after industrial or closed space fire • Heart failure consider cyanide poisoning • Acute respiratory distress syndrome Approved For suspected closed space Burn Receiving Centers inhalation, choose Severe Assess Airway Involvement path Airway St. Francis – San Francisco 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, no soot in the of the following: Wheezing, presence of sounds and definitive airway felt necessary oropharynx or nasopharynx, nasal hairs soot/singed nasal hairs, change in voice, OR intact, low likelihood of airway carbonaceous sputum, increased work of Any combination of the following: Airway involvement breathing/tachypnea. edema, stridor, presence of soot/singed nasal hairs, change in voice, carbonaceous sputum, increased work of breathing/ tachypnea. Monitor and reassess If oxygen saturation ≥ 92% E Apply Oxygen to maintain goal Routine Medical Care SpO2 > 92% Airway Field Procedure Cardiac monitor CO-oximetry (SpCO), if available Monitor and reassess Head Trauma Consider, 12-Lead ECG P E High flow Oxygen Consider, 2 IV/IO sites Regardless of SpO2 Pain Cardiac monitor Consider, Albuterol Consider, 12-Lead ECG Burns Consider, 2 IV/IO sites Notify burn center. P Carbon Monoxide/ Consider Base Hospital Albuterol Cyanide for medical direction Epinephrine 1:1,000 nebulized for stridor Hazmat CPAP Hypotension Closest receiving facility for definitive airway. Eye Injury Consider Base Hospital for medical direction Treatment Protocol R07 Page 1 of 2 EffectiveEffective November October 2018 2019 San Mateo County Emergency Medical Services 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 R07 Page 2 of 2 EffectiveEffective November October 2018 2019.

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