What out-of-hospital interventions can be done for a patient with inhalation poisoning?

Out-of-Hospital Interventions for Inhalation Poisoning

The most critical out-of-hospital intervention for inhalation poisoning is immediate administration of 100% normobaric oxygen to any person suspected of having carbon monoxide or other toxic inhalation poisoning while awaiting confirmation of diagnosis. 1

Initial Management

• Remove the victim rapidly and safely from the exposure source without placing yourself in danger 1
• Administer 100% normobaric oxygen immediately via high-concentration mask to accelerate elimination of toxins such as carboxyhemoglobin (COHb) 1, 2
• Continue oxygen therapy for 6-12 hours, or until symptoms resolve and COHb levels normalize (<3%) 1
• For patients with suspected smoke inhalation, assess for both carbon monoxide and cyanide poisoning, as cyanide is a major component of fire smoke 1, 3
• Activate emergency medical services immediately for any patient exhibiting signs of life-threatening conditions (e.g., altered mental status, difficulty breathing, seizures) 1

Specific Interventions by Poison Type

Carbon Monoxide Poisoning

• Administer 100% normobaric oxygen which reduces COHb half-life from 320 minutes on room air to approximately 74 minutes 1, 2
• Remove all contaminated clothing and ensure the patient is not re-exposed to the source 1
• Consider hyperbaric oxygen therapy (HBOT) for severe cases, particularly those with loss of consciousness, neurological deficits, or significant metabolic acidosis 1, 2
• For pregnant women with suspected CO poisoning, HBOT should be considered regardless of clinical presentation 1, 2

Cyanide Poisoning

• Recognize symptoms including headache, nausea, shortness of breath, altered mental status, and metabolic acidosis 1, 3
• For smoke inhalation victims with suspected cyanide poisoning, hydroxocobalamin is the preferred antidote as it has no serious side effects or deleterious cardiovascular effects 4, 3
• Cyanide poisoning requires immediate treatment as it can be fatal within minutes 3

Chemical Exposures

• For chemical burns, brush powdered chemicals off the skin with a gloved hand or cloth 1
• Remove all contaminated clothing without contaminating yourself 1
• For acid or alkali exposure on skin or eyes, immediately irrigate with copious amounts of water 1
• Do not administer anything by mouth for any poisoning ingestion unless advised by poison control or emergency medical personnel 1

Special Considerations

• For patients with combined CO and cyanide poisoning from structure fires, prioritize oxygen therapy while also considering specific antidotes for cyanide 1, 4
• Patients with burns and inhalation injuries may require special consideration for evacuation and transport 1
• For organophosphate poisoning, atropine and pralidoxime may be indicated, with atropine given only after hypoxemia is improved 5
• Contact poison control centers (e.g., 800-222-1222 in the US) for guidance on specific poisonings 1

Common Pitfalls and Caveats

• Do not delay oxygen administration while awaiting laboratory confirmation of poisoning 2
• COHb levels may be normal or low if several hours have elapsed since exposure, so don't rule out CO poisoning based solely on COHb levels 2
• Do not attempt to induce vomiting or administer activated charcoal for inhalation poisonings 1, 6
• Ensure the poisoning source is identified and eliminated before the patient returns to the environment to prevent re-exposure 1
• Remember that symptoms of cyanide toxicity cannot be treated with supplemental oxygen alone and require specific antidotes 3