Engine 3 / Medic 1 · 18 min · ground

House fire — inhalation injury

ARDSNet ARMA / ALVEOLI · ATS 2024 · ARDSNet: 6 mL/kg PBW · Pplat ≤30 · ΔP ≤14 · SpO₂ 88–100 · PaCO2 ~35–45

Load card puts the starting breath on the box. Connect starts the clock. End whenever you want.

44-year-old pulled from a bedroom fire. Soot in the mouth, singed nasal hair, 18% TBSA partial thickness.

Rest of the scene

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.

3 objectives
  1. 1

    ARDSNet 6 mL/kg PBW, Pplat ≤30 — drop toward 4 if Pplat climbs

    Inhalation injury is ARDS with soot. Same ARMA rules.

  2. 2

    PEEP/FiO2 on the ARDSNet table

    Lower table at FiO2 0.80 = PEEP 14. Step 2 cm. No 40-second hold.

  3. 3

    Keep VTE real as secretions climb

    Falling VTE at the same Pinsp is a tube or a pneumo.

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