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 if indicated Cardiac monitor

CO‐oximetry (SpCO), if available Trauma Monitor and reassess Consider, 12‐Lead ECG if indicated P E High flow Oxygen Consider, 2 IV/IO sites Regardless of SpO2 Pain if indicated Cardiac monitor Consider, Albuterol Burn Consider, 12‐Lead ECG if indicated Consider, 2 IV/IO sites Carbon Monoxide/ Notify burn center. P Cynaide Consider Base Hospital Albuterol if indicated for medical direction Epinephrine 1:1,000 nebulized for stridor Hazmat if indicated CPAP

Hypotension if indicated Closest receiving facility Exit to Eye Injury for definitive airway. if indicated Consider Base Hospital for medical direction

Treatment Protocol R07 Page 1 of 2 Effective November 2018Effective October 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 Effective November 2018Effective October 2019