Engine 3 / Medic 1 · 18 min · ground

House fire — inhalation injury

ARDSNet ARMA / ALVEOLI · ATS 2024 · FiO2 100% while CO is plausible — pulse ox lies; then ARDSNet 88–95 · ARDSNet / SSC: 6 mL/kg PBW; drop 1 mL/kg toward 4 if Pplat >30 · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 ~35–45

44-year-old pulled from a bedroom fire. Soot in the mouth, singed nasal hair, 18% TBSA partial thickness. Tubed in the yard with a 7.5 after the voice went hoarse. HME already looking dirty.

Handoff

This is chemical ARDS plus secretions. Start ~6 mL/kg, PEEP for the wet lung, FiO2 for the sat — and expect the tube to foul. Do not hold a prolonged recruitment maneuver. Burn center is 18 minutes.

1
ARDSNet 6 mL/kg PBW, Pplat ≤30 — drop toward 4 if Pplat climbs
Inhalation injury is ARDS with soot. Same ARMA rules.
2
PEEP/FiO2 on the ARDSNet table
Lower table at FiO2 0.80 = PEEP 14. Step 2 cm. No 40-second hold.
3
Keep VTE real as secretions climb
Falling VTE at the same Pinsp is a tube or a pneumo.

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