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Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
Secret Firefighter Killers
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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.

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