Secret Firefighter Killers

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Presentation of Secret Firefighter Killers given during OEMTA Public Safety Conference in 2013. Discusses the Toxic Twins and Emergency Smoke Inhalation Treatment including Cyanokit.

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Secret Firefighter Killers

  1. 1. Secret Firefighter Killers
  2. 2. Joe Sherrell EMS Officer Tulsa Fire Department (918) 596-9808 jsherrell@cityoftulsa.org
  3. 3. 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
  4. 4.  RIT has removed the downed firefighter…
  5. 5. SMOKE
  6. 6. Smoke the gaseous products of burning materials especially of organic origin made visible by the presence of small particles of carbon a suspension of particles in a gas ww.merriam-webster.com
  7. 7. Read It – Don’t Breathe ItRead It – Don’t Breathe It Advantages:Advantages:  LocationLocation  IntensityIntensity  ProgressionProgression  EffectivenessEffectiveness  Tactical MarkerTactical Marker
  8. 8. 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
  9. 9. Smoke = PoisonSmoke = Poison
  10. 10. TOXIC TWINS
  11. 11. Toxic Twins  Carbon Monoxide (CO)  Hydrogen Cyanide (HCN)
  12. 12. Carbon Monoxide (CO)
  13. 13. Properties  Colorless  Odorless  Tasteless  Flammable  Gas
  14. 14. Where does it come from?  Produced when carbonaceous materials are burned with insufficient oxygen.
  15. 15. Annual Stats  Over 2,000 deaths  Several hundred thousand exposed  20-40% suffer health damage
  16. 16. Physiologic Effects  250 times the affinity for hemoglobin  Displaces O2  Leads to Hypoxia
  17. 17. Symptoms  Headache  Lethargy/Fatigue  Nausea  Dizziness  Confusion  Dyspnea  Palpitations  Convulsions  Paralysis  LOC  Coma  Death
  18. 18. Hydrogen Cyanide (HCN)
  19. 19. Properties  Colorless  Bitter Almond Odor  Gas
  20. 20. Sources in Fire Products  Polyurethane Foam  Synthetic Rubber  Nylon  Asphalt  Wool  Silk
  21. 21. Physiologic Effects  Prohibits the cells from using oxygen  Respiratory Paralysis  Cardiac Irregularities
  22. 22. Symptoms – Low Levels  Bitter almond odor  Burning taste  Numb Throat  Salivation  Nausea/Vomiting  Anxiety  Confusion  Vertigo  Ataxia  Giddiness
  23. 23. Symptoms – Moderate Levels  Hyperpnea  Dyspnea  Tachypnea  Short Inspiration  Prolonged Expiration  Tachycardia
  24. 24. Symptoms – High Levels  LOC  Coma  Protruding eyeballs  Pupils dilated  Bradycardia  Respiratory Arrest  Arrhythmias  Convulsion  Hypotension  Incontinence  Paralysis  Sweating
  25. 25. Toxic Twins  Carbon Monoxide  Attacks the blood  Hydrogen Cyanide  Attacks the cells
  26. 26. ASSESSMENT
  27. 27. 1st Priority  Move to a safe area  Remove Gear  Emergency Decon
  28. 28. Initial Assessment  ABCs  Mental Status  EtCO2  CO Treat Life-Threats Immediately
  29. 29. TREATMENT
  30. 30. BLS  Airway  Suction  Airway Adjunct  Breathing  High-flow O2  NRB or BVM  Circulation  CPR
  31. 31. ALS  Advanced Airway  Establish IV/IO  Large Bore
  32. 32. Treat for CN Poisoning Confined space with smoke? Soot around mouth/nose? Altered Mental Status?
  33. 33. Cyanokit Study 69 Patients 73% Survived  Of the 19 subjects who did not survive, 13 were presented in cardiac arrest.
  34. 34. Blood Draw  Cyanokit may interfere with lab tests  If time allows, draw 2 vials of blood
  35. 35. Mechanism  Attaches to cyanide ion  Allows cells to utilize O2  Excreted in urine
  36. 36. Contraindication  Hx of allergic reaction  Safety not established in pediatrics  Safe even without cyanide exposure
  37. 37. Side Effects  Hypertension  Red Discoloration
  38. 38. Precaution  Use a separate IV/IO line
  39. 39. Dosing  5g over 15 minutes
  40. 40. Preparation  Glass Bottle  Mix 200 cc of NS  Don’t Shake
  41. 41. Administration  IV/IO  Mix with 200 cc Saline  Leave box in place  15 minutes  “Power Syringe”
  42. 42. Tulsa Kit Carried by: District Chiefs EMS Supervisor (C835)
  43. 43. Assigned Apparatus Expiration Security Seals
  44. 44. Tulsa Kit  Cyanokit  Drug  Transfer Spike  Vented IV Tubing  NS 100cc (2)  Syringe 30cc  Stopcock  Extension Set  Needle  Vaccutainer (2)
  45. 45. TRANSPORT
  46. 46. Hyperbaric Oxygen Therapy  Consider if:  GCS ≤ 13  Pregnancy  Consult OLMC  Facilities  OSUMC (Tulsa)  Integris Baptist (OKC)
  47. 47. Care Transfer  Describe Scene  Cyanokit Use  Provide Blood Samples
  48. 48. Summary •Toxic Twins •Move to a safe area •Rapid Assessment •Oxygenation/Ventilatory Support •Cyanokit
  49. 49. Questions
  50. 50. 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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