# Burns & smoke inhalation

Support oxygenation, address pain and perfusion, and recognize burn-center referral criteria.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/burns/
Official source: [SO-E-005 — Burn (Thermal, Electrical, Chemical) - Adult](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- SpO₂ may look reassuring despite significant CO exposure.
- Burn size alone does not determine destination: location, depth, mechanism, and comorbidities also matter.

## Source documents

- [SO-E-005 — Burn (Thermal, Electrical, Chemical) - Adult](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf)
- [PR-130 — Hydroxocobalamin for Cyanide Toxicity](https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf)

## Initial care

- For enclosed-space or heavy-smoke exposure, give high-flow oxygen by mask as tolerated. Pulse oximetry may be misleading with carbon-monoxide exposure.
- Use cooling measures for a still-symptomatic burn. For wheeze/suspected smoke inhalation, the source lists albuterol 5 mg/6 mL by continuous nebulization as tolerated.

## Pain & circulation

- Do not inject analgesics or place IV access through burned skin. With systolic BP above 90, options include morphine 5 mg (or 4 mg carpuject) IV/IM, or fentanyl 50 mcg IV/IM or 100 mcg IN; one repeat after 3 minutes is permitted as specified. Morphine IO use is limited to already-established access for saline.
- For systolic BP at or below 90 or shock signs, establish access through unburned skin and give 250 mL saline boluses up to 1 L to maintain perfusion.

## Burn-center contact

- Contact base for suspected inhalation injury, electrical/lightning injury, or chemical burns; burns involving face, hands, feet, genitalia, or perineum; circumferential burns; or relevant complicating disease.
- The source also includes second-degree burns above 10% TBSA and any third-degree burn. Base coordinates the burn-unit destination.

## Chemical & electrical injuries

- Brush away residual dry chemical. The source generally directs copious continuous water/saline irrigation, but specifically warns that some chemicals react dangerously with water; identify the substance and use appropriate hazard guidance.
- Small-looking electrical wounds can conceal major deep injury and rhythm risk. Provide cardiac monitoring and ALS escort for the high-voltage exposure described by the source.
- For suspected cyanide exposure, use PR-130/base-directed hydroxocobalamin rather than assuming every smoke exposure needs an antidote.