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