Smoke & Carbon Monoxide Inhalation

UNCONTROLLED WHEN PRINTED

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.

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

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
- Provide supportive ventilation if necessary
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)

Additional Information

Collect clothing and place in contamination waste bag and seal (may be needed for identification purposes).

References

Key Terms & Links

Colour assist:

Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Published Date

Review Date