This protocol should be utilized ONLY for the management of symptomatic patients after exposure to smoke in an enclosed space and cyanide exposure is suspected. 1. Begin Basic Life Support Procedures 2. If necessary, perform Advanced Airway Management *. 3. Begin Cardiac & Pulse Oximetry monitoring. 4. Begin SpCO monitoring, if available 5. Begin two IV infusions of Normal Saline (0.9% NS). Refer also to Protocol #528 for all patients with burns. 6. Patients with the following symptoms, after exposure to smoke in an enclosed space, should be administered the medications listed in Table 1 or Table 2, if available. • Hypotension not attributable to other obvious causes • Altered mental status • Coma • Seizures • Respiratory arrest • Cardiac arrest NOTE: Prior to administration of Hydroxocobalamin, obtain three blood samples using the tubes provided in the cyanide toxicity kit. Whenever Hydroxocobalamin is administered, follow with a 20 ml flush of normal saline (0.9% NS) prior to administration of any other medication. 7. In the event of continued hypotension (SBP