EMS Protocol of the Week - Smoke Inhalation (Adult and Pediatric) and Cyanide Exposure (Adult and Pediatric)

The NYC prehospital approaches to smoke inhalation and cyanide exposure are nearly identical, so it’s worth knocking them both out at once. Both protocols start with ABCs and burn management, and both then focus on the administration of cyanide toxicity kits for post-exposure patients who are symptomatic. You can refer to the PDFs directly for advice on dosing and administration considerations (remember: hydroxocobalaminBEFORE sodium thiosulfate to avoid medication inactivation!). Otherwise, note that prior to administering the cyanide toxicity kit is the ONLY instance in these protocols where paramedics are trained and ordered to draw blood (for pre-medication cyanide levels). 

The key difference in the protocol for cyanide exposure is the early recognition of a possible MCI scenario, which would require a Class Order for widespread medication orders that would then be dispatched through our OLMC line. We touched on this months ago with the WMD protocol and the use of nerve agent antidotes.

Scary stuff, but always better to be aware ahead of time! Want to get even MORE ahead? Check out www.nycremsco.org or the protocol binder to stay on top of it all!

Dave

EMS Protocol of the Week - Carbon Monoxide (Adult and Pediatric)

Anyone else start getting that dusty, musty smell from the heater in your apartment running for the first time since spring? Anyone get headaches with that must? Nausea, confusion? Syncope?

The prehospital protocol for carbon monoxide poisoning is primarily about recognition. Some services may carry CO monitors that can measure a patient’s SpCO, much like a pulse oximeter, but the more important thing is to have a healthy clinical suspicion for it the same way you would in the ED. Often, these crews will be responding to the scene of a fire, or where a CO detector has gone off, so ensuring scene safety is obviously the other crucial part of this approach.

Speaking of fires, what other considerations do we have for EMS when flames are involved? Stay tuned to find out! www.nycremsco.org or the protocol binder until then.

Dave

EMS Protocol of the Week - Stridor / Croup / Epiglottitis (Pediatric)

Last month, we discussed prehospital assessment and management of the obstructed airway, as well as the approach to anaphylaxis. This separate protocol for croup and epiglottitis refers to those prior protocols based on the provider’s clinical impression, but on its own, it serves to remind EMTs and paramedics of the warning signs to note and cautions considerations to make when dealing with potentially inflammatory etiologies in kids. Basically – do very little, and get the patient to definitive management with as little fuss as possible.

Easy, right?

www.nycremsco.org or the protocols binder to tide you over til next week!

 Dave