Page 278 - ATP-P 11th Ed

SMOKE INHALATION / CHOKING AGENT /
TOXIC INDUSTRIAL CHEMICALS (TICs) PROTOCOL

SPECIAL CONSIDERATIONS
1. Consider possible carbon monoxide (CO) poisoning and need for hyperbaric
oxygen in all significant cases of smoke inhalation.
2. Normal oxygen saturation by pulse oximetry DOES NOT rule out the possibil-
SECTION 2 3. Burns to the upper airway may not be immediately obvious. Strong consider-
ity of CO poisoning.
ation should be given to early airway intervention if upper airway burns are
suspected or edema is present.
4. Choking agents/TICs (ammonia, bromine, chlorine, hydrogen chloride, or phos-
gene) cause immediate and/or delayed symptoms.

Signs and Symptoms
1. History of smoke exposure
2. Burns
3. Eyes. See Corneal Abrasions/Ulcer/Conjunctivitis Protocol (2. and 3.), nose, throat,
and skin irritation
4. Coughing
5. Respiratory distress to include wheezing and pulmonary edema (may be delayed in
onset)

Management
1. Administer oxygen.
2. Consider the use of early intubation or cricothyroidotomy if airway burns/edema or
singed nasal hair, facial burns are present/suspected. High PEEP may be required.
3 Albuterol (Ventolin ) by metered dose inhaler 2–4 puffs q4–6hr
®
4. Dexamethasone (Decadron ) 10mg IV/IM qd
®
5. Limit patient exertion if possible (worsens prognosis in chemical exposures).
6. Observe asymptomatic choking agent/TIC exposures for delayed onset of symptoms
(12–24 hours).

Disposition
1. Urgent evacuation for respiratory distress, suspected inhalation burns.
2. Priority evacuation if not in distress but significant inhalation suspected.

268 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 269