Secret Firefighter Killers
Objectives Define Smoke Discuss the contents of fire smoke List the physical properties of CO and CN Describe the effects of CO & CN List the symptoms related to CO & CN
exposure Discuss the assessment method Discuss the treatment for smoke inhalation Understand the use of Cyanokit
RIT has removed the downed firefighter…
SMOKE
Smoke
the gaseous products of burning materials especially of organic originmade visible by the presence of
small particles of carbon
a suspension of particles in a gas
www.merriam-webster.com
Read It – Don’t Breathe ItRead It – Don’t Breathe It
Advantages:Advantages: LocationLocation Intensity Intensity ProgressionProgression EffectivenessEffectiveness Tactical MarkerTactical Marker
Smoke ContentsSmoke Contents•Hydrochloric AcidHydrochloric Acid•Sulfur DioxideSulfur Dioxide•Oxides of NitrogenOxides of Nitrogen•AmmoniaAmmonia•Carbon DioxideCarbon Dioxide•Hydrogen CyanideHydrogen Cyanide•Carbon MonoxideCarbon Monoxide•Hydrogen SulfideHydrogen Sulfide
Smoke = Smoke = PoisonPoison
TOXIC TWINS
Toxic Twins
Carbon Monoxide (CO) Hydrogen Cyanide (HCN)
Carbon Monoxide(CO)
Properties
Colorless Odorless Tasteless Flammable Gas
Where does it come from?
Produced when carbonaceous materials are burned with insufficient oxygen.
Annual Stats Over 2,000 deaths Several hundred thousand
exposed 20-40% suffer health damage
Physiologic Effects 250 times the affinity for
hemoglobin Displaces O2
Leads to Hypoxia
Symptoms
Headache Lethargy/
Fatigue Nausea Dizziness Confusion Dyspnea
Palpitations Convulsions Paralysis LOC Coma Death
Hydrogen Cyanide(HCN)
Properties
Colorless Bitter Almond Odor Gas
Sources in Fire Products
Polyurethane Foam Synthetic Rubber Nylon Asphalt Wool Silk
Physiologic Effects Prohibits the cells from using
oxygen Respiratory Paralysis Cardiac Irregularities
Symptoms – Low Levels
Bitter almond odor
Burning taste Numb Throat Salivation Nausea/Vomiting
Anxiety Confusion Vertigo Ataxia Giddiness
Symptoms – Moderate Levels
Hyperpnea Dyspnea Tachypnea Short Inspiration Prolonged Expiration Tachycardia
Symptoms – High Levels
LOC Coma Protruding
eyeballs Pupils dilated Bradycardia Respiratory
Arrest
Arrhythmias Convulsion Hypotension Incontinence Paralysis Sweating
Toxic Twins
Carbon Monoxide Attacks the blood
Hydrogen Cyanide Attacks the cells
ASSESSMENT
1st Priority
Move to a safe areaRemove GearEmergency Decon
Initial Assessment
ABCsMental StatusEtCO2
CO
Treat Life-ThreatsImmediately
TREATMENT
BLS Airway
Suction Airway Adjunct
Breathing High-flow O2
NRB or BVM
Circulation CPR
ALS
Advanced Airway Establish IV/IO
Large Bore
Treat for CN Poisoning
Confined space with smoke?
Soot around mouth/nose?Altered Mental Status?
Cyanokit Study
69 Patients73% Survived Of the 19 subjects who did not
survive, 13 were presented in cardiac arrest.
Blood Draw
Cyanokit may interfere with lab tests
If time allows, draw 2 vials of blood
Mechanism
Attaches to cyanide ion Allows cells to utilize O2
Excreted in urine
Contraindication
Hx of allergic reaction Safety not established in pediatrics
Safe even without cyanide exposure
Side Effects
Hypertension Red Discoloration
Precaution
Use a separate IV/IO line
Dosing
5g over 15 minutes
Preparation
Glass Bottle Mix 200 cc of NS Don’t Shake
Administration
IV/IO Mix with 200 cc Saline Leave box in place 15 minutes “Power Syringe”
Tulsa Kit
Carried by:
District ChiefsEMS Supervisor (C835)
Assigned Apparatus
Expiration
SecuritySeals
Tulsa Kit Cyanokit
Drug Transfer Spike Vented IV Tubing
NS 100cc (2) Syringe 30cc Stopcock Extension Set Needle Vaccutainer (2)
TRANSPORT
Hyperbaric Oxygen Therapy
Consider if: GCS 13 Pregnancy
Consult OLMC
Facilities OSUMC (Tulsa) Integris Baptist (OKC)
Care Transfer
Describe Scene Cyanokit Use Provide Blood Samples
Summary
•Toxic Twins
•Move to a safe area
•Rapid Assessment
•Oxygenation/Ventilatory Support
•Cyanokit
Questions
References
Bledsoe, Malone, Slattery, Carrison, Evans, Johnson. Cyanide, Carbon Monoxide or Both? A protocol for an Organized Response to the Downed Firefighter or Victim of Toxic Gas Exposure.
Cyanokit Administration Guide
Eckstein, Mark & Manisacalco, Paul. Focus on Smoke Inhalation – The most Common Cause of Acute Cyanide Poisoning. 2006.
Mcevoy, Mike. Cyanokit Setup and Administration. www.firengineering.com
Penney, David G. The Toxic Twins: An advanced Perspective on Cyanide and Carbon Monoxide Poisoning
Shapiro, Arnold. Rescue 911 Episdoe-522.
State of Oklahoma Department of Health EMS Protocols
Smoke Inhalation & Hydrogen Cyanide Poisoning. Journal of Emergency Medical Services. 2004.
Schnepp, Rob. To Hell and Back. The Peoples Burn Foundation
Zemeckis, Robert, 1994. Forrest Gump. Paramount.
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