›Immediate stabilization workflow
›Resuscitation bay criteria
›Stridor
›Altered mental status
›SpO2 less than 90 percent on oxygen
›Hypotension
›Monitoring
›Continuous pulse oximetry
›Cardiac monitor
›Frequent vitals
›IV access
›Two large bore IV for unstable patients
›IO if no IV and crashing
›Oxygen
›100 percent oxygen via non rebreather initially for CO concern
›High flow nasal cannula for persistent hypoxemia when protecting airway
›Airway plan
›Early intubation for evolving upper airway edema
›Difficult airway backup
Airway and breathing management
›Airway strategy
›If stridor or progressive airway edema then intubation without delay
›Smaller endotracheal tube may be required with edema
›Surgical airway preparation for severe facial burns or obstruction
›Bronchospasm treatment
›Albuterol nebulized dosing per medication section
›Ipratropium nebulized dosing per medication section
›Magnesium sulfate IV for severe asthma phenotype
›Adult 2 g IV over 20 minutes
›Secretion and airway toilet
›Humidified oxygen
›Suctioning
›Chest physiotherapy local protocol dependent
Carbon monoxide management
›CO poisoning treatment
›100 percent oxygen until symptoms resolve and carboxyhemoglobin improves
›Hyperbaric oxygen consult criteria
›Loss of consciousness
›Severe metabolic acidosis
›Pregnancy with elevated carboxyhemoglobin
›Persistent neurologic symptoms
›Myocardial ischemia
Cyanide toxicity management
›Cyanide high risk pathway
›Hydroxocobalamin dosing per medication section
›Early poison center consultation
›Hemodynamic support
›Crystalloid bolus for hypotension
›Norepinephrine infusion for persistent shock
›Start 0.05 mcg per kg per minute
›Titrate every 2 to 5 minutes to MAP target
Burns and associated trauma
›Burn care priorities
›Burn center consultation triggers
›Suspected inhalation injury
›Facial burns
›Large total body surface area burns
›Circumferential burns
›Fluid resuscitation considerations
›Parkland formula use for major burns
›Avoid over resuscitation in isolated inhalation without major burns
›Testing order
›Co oximetry early when CO concern
›VBG and lactate early when cyanide concern
›Chest x ray for baseline and alternative diagnoses
›Reassessment timing
›Every 15 to 30 minutes during initial stabilization
›After each bronchodilator cycle
›After oxygen escalation
›Reassessment targets
›Work of breathing
›Mental status
›SpO2 trend
›Need for airway intervention
›Hemodynamics