Smoke Inhalation

[Guardian]

Had a fire a month ago that resulted in multiple firefighter smoke inhalation complaints. Because of this, I decided to review smoke inhalation and treatment. I would like your input on this subject and especially comments toward hospital treatment of smoke inhalation and/or links to such info. Here is what I got so far, thanks guys.

EMS:

Firefighters need to wear scba!

Routine checks of v/s after 2 scba tanks used by firefighter.

Be aware of s/s or CO poisoning, followed by Cyanide poisoning and other chemicals such as amyl nitrite, and hydrocarbons.

Transport any signs of acute toxic poisoning and treat accordingly.

Be very carefully with airway swelling and pulmonary edema.

Hospitals:

Check CO blood levels

Check lactic acid levels

Possibly check Cyanide levels or other chemical if suspected.

Possibly use hyperbaric chamber, so make sure hospital has a hyperbaric chamber and/or ability to test Cyanide.

What am I missing?

 

[Ridryder911]

Usually before lactic etc.. room air ABG's, CXR, vQ, D-dimer, ... HBO is not always beneficial, some use it some say its taboo for Co for short duration exposures...

R/r 911

 

[Guardian]

Usually before lactic etc.. room air ABG's, CXR, vQ, D-dimer, ... HBO is not always beneficial, some use it some say its taboo for Co for short duration exposures...

R/r 911

thanks a lot!! Chest x-ray, i knew that. Why D-dimer, why would we look for clots? I figure HBOT couldn't hurt.

 

[Guardian]

also, can most level 1 trauma or big hospitals check for cyanide?

 

[rescuecpt]

If at all possible, it's nice to have baseline vitals on the firefighters... in my old department when we set up our incident rehab kit, part of it was that every member had complete vitals taken, one copy was put in their personnel file (which is private) and the other copy was sealed in an envelope inside the rehab box. That way, on a scene, we know what their EKG normally looks like, and whether they normally have high bp, etc. We also had an idea of what meds they take and what medical issues they had, so if FF collapses, we can try to treat him appropriately. The plan was going forward the files would be updated every year, when they do their fit tests. I left before the plan had been in place that long.

 

[Ridryder911]

From seeing and being on both sides, usually "smoke inhalation " is treated symptomatically. Usually, they are minor to moderate cases, the usual oxygen therapy, bronchodilators..all dependent usually on ABG's, EtCo2 level, as well as CO level... etc.

Severe cases may be treated as respiratory burns, ans chemical exposures as well. If intubation is required, different forms of ventilator settings may be explored, all dependent on the case and pulmonologist. Fluid re hydration, prophylactic antibiotics, as well as bronchodilators, respiratory treatments, V/q scans, pulmonary function tests, possible HBO (hyperbaric tx) and so on...

Continues monitoring of CO level, and even a neuro consult is not out of sequence, after discharge.

BE safe,
R/r 911

 

[ffemt8978]

We do baseline vitals on all of our FF's when they do their quarterly SCBA certification. We keep copies of these in each ambulance in a rehab log book.

 

[Luno]

Baseline Vitals

OMG, now I feel sheepish.... Of all the stuff we do, including full medical records on team members, med lists, allergies and yearly physicals, etc... We don't carry our team's baseline vitals! They say you learn something every day, this is my thing for today, thanks erica.