EMS Protocol of the Week - Smoke Inhalation

Hello all, 

This week's EMS Protocol is brought to you by my obsession with the HBO smash hit House of the Dragon. 

Picture this -- Two Westerosi men walk into a King's Landing bar. They see Princess Rhaenyra and strike up a heated conversation to delight her. After exhausting all the advances in their arson-al, they realize they're no match. Syrax, fuming at this show of smoke and mirrors, suggests they use Tinder and burns them to the ground. EMS arrives at the scene and then has to deal with the rest of the patrons...

Enter the REMAC protocol for smoke inhalation!

-In general, always start with ABC's -- airway is critical.

-Place patients on NRB for O2.

-EMTs can measure carbon monoxide (SpCO) with a pulse co-oximeter.

              -Keep in mind SpCO measured by an external pulse co-ox is less reliable compared to that calculated from blood co-oximetry.

              -Consider transfer to a facility with hyperbaric capabilities (like Jacobi) if you suspect CO poisoning.

-Medics perform advanced airway management.

              -Have a low threshold to use DL/VL.

              -Intubate early for soot/edema in airway, neck burns, progressive hoarseness, AMS.

-Treat cyanide poisoning early (stay tuned for more info).

Don't forget to check out www.nycremsco.org and the protocol binder for more and reach out for questions!

Remember: Winter is coming. And with winter, comes more electric/gas heating fires and potential for burn/smoke injures.

Best,

Chris Kuhner, MD

PGY-2 Emergency Medicine