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Quick Chart
Introduction
  • Burning materials, chemicals, and the gases created can cause smoke inhalation by simple asphyxiation (lack of oxygen), chemical irritation, chemical asphyxiation, or a combination of them. 
  • Smoke inhalation occurs when you breathe in harmful smoke particles and gases. Inhaling harmful smoke can inflame your lungs and airway, causing them to swell and block oxygen. This can lead to acute respiratory distress syndrome and respiratory failure.

Read the complete article; Smoke Inhalation Injury in the Medical Library > Pathophysiology.

Clinical Presentation
  • Altered Conscious State (note: may be delayed; may also present as changes in behaviour, neurological, or mental status.)
  • Cough
  • Shortness of breath
    • Stridor
    • Wheeze
    • Hoarseness
  • Headache
  • Skin changes
    • Cyanosis - hypoxia
    • Bright red - carbon monoxide poisoning (very late sign)
    • Burns
  • Eye damage
  • Seizures
  • Soot in the nose or throat
  • Chest pain
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Decision will be made at nearest Emergency Department regarding the need for emergency hyperbaric oxygen therapy
  • Smoke inhalation or carbon monoxide (CO) poisoning is almost always the result of a patient being exposed to a toxic environment
  • A very high index of suspicion regarding your safety from the environment MUST be upheld when attending these patients
  • If there is any suspicion of danger seek further expert advice: i.e. Department of Fire and Emergency Services (DFES); if on-site, contact minesite rescue or obtain local knowledge BEFORE entering
    • Refer to Material Safety Data Sheet (MSDS) for specific instructions
    • Contact Poison Information Centre if required on 13 11 26
    • Safety is a priority; remain at a safe distance, uphill and upwind until advised by DFES or appropriate agency that it is safe to enter the area
  • The standard Personal Protective Equipment (PPE) provided for ambulance personnel DO NOT protect against noxious gases. If in any doubt contact Ambulance Operations Centre for advice
  • Consider activating Special Operations Paramedics via CSPSOC or Duty Manager
  • Be aware of false positives from SpO2 monitoring
Management
Primary Care
  • Primary survey
    • DO NOT enter an unsafe scene, regardless of whether patients are present
    • Preferably have the patient extricated to the ambulance by properly trained and protected personnel
  • Administer oxygen via high concentration mask to clear the noxious gas
  • Position as appropriate for patient’s condition
  • Reassurance (continuous)
  • If there are signs of skin irritation, shower patient for 20 minutes and / or continue irrigation en route.
  • Perform vital sign survey
  • Secondary / CNS Survey
Intermediate Care (EMT / Level 2)
  • Apply cardiac monitor if trained and authorised
  • If wheeze present, consider salbutamol
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
    • Consider Fiona Stanley Hospital as hyperbaric treatment may be necesary
Advanced Care (AP)
  • Apply cardiac monitoring
  • If wheeze present, consider salbutamol
  • Establish vascular access
  • Consider obtaining prehospital blood sample
  • Consider normal saline to treat hypotension
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
    • Consider Fiona Stanley Hospital as hyperbaric treatment may be neccesary
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Collect clothing and place in contamination waste bag and seal (may be needed for identification purposes).

References
References
Key Terms & Links
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