Page 148 - 2022 Ranger Medic Handbook

Smoke Inhalation
DEFINITION: Common after closed space exposure to fire; consider airway burns, carbon monoxide poisoning, other
toxin inhalation, and need for hyperbaric oxygen.
S/Sx: History of smoke exposure; burns (singed nares, facial burns); coughing; stridor; +/– carbonaceous sputum;
respiratory distress (may be delayed in onset).
MANAGEMENT:
1. Remove from environmental exposure and allow patient to rest.
2. Administer oxygen if available.
3. Refer to Airway Management Protocol and consider the use of early cricothyroidotomy if airway burns/edema or
singed nasal hair, facial burns are present/suspected.
SECTION 3 5. Dexamethasone 10mg IV/IM qd.
4. Albuterol by metered dose inhaler 2–4 puffs q1hr or nebulizer if available.
6. Patient exertion will exacerbate symptoms and should be avoided.
DISPOSITION: Urgent evacuation for respiratory distress, suspected inhalation burns. Priority evacuation if not in dis-
tress but significant inhalation suspected.
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 possibility of CO poisoning.
3. Consider cyanide poisoning or coexisting trauma in hypotensive burn patient.

Spontaneous Pneumothorax
DEFINITION: Acute onset of pneumothorax usually without obvious or known chest trauma.
S/Sx: Spontaneous unilateral chest pain; dyspnea – typically mild; no wheezing; cough; decreased or absent breath
sounds on affected side
MANAGEMENT:
1. Pulse oximetry monitoring.
2. Oxygen if available (use oxygen for all suspected spontaneous pneumothoraces).
3. Consider needle decompression for suspected tension pneumothorax.
4. If needle decompression allows for patient improvement, followed by worsening of condition, consider repeat needle
decompression.
5. Consider tube thoracostomy if recurrence of respiratory distress after 2 successful needle decompressions OR Evac-
uation time > 1 hour OR patient requires positive pressure ventilation.
6. If at altitude, descend as far as tactically feasible.
7. If evacuation will occur in an unpressurized aircraft, consider decompression for high altitude evacuation and recom-
mend lowest tactically feasible altitude.
8. Treat per Pain Management Protocol.
DISPOSITION: Urgent evacuation for significant respiratory distress despite therapy. Priority evacuation for patients
whose respiratory status is stable.
SPECIAL CONSIDERATIONS:
1. Consider also: anaphylaxis, pulmonary embolism, high altitude pulmonary edema (HAPE), asthma, myocardial infarc-
tion and pneumonia.
2. More common in tall, thin individuals and smokers.

134 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL