ANTIDOTE TO SKIN

Gastrointestinal decontamination must be administered quickly. They must be removed from the source and have their clothing removed and discarded appropriately. ĭecontamination is a vital part of the management of a patient with cyanide exposure through topical and inhalation routes. Of note, mouth-to-mouth resuscitation is contraindicated in cyanide poisoning because of the risk to the provider of CPR. Given the profound effects of cyanide toxicity, the provider must prepare to stabilize the patient's airway, breathing, and circulation.

Given this fact, the clinician must rely on the presenting symptoms and the general clinical status of the patient. The results of direct testing are often unreliable because proper storage and prompt blood draws are needed. It is also advisable to get a carboxyhemoglobin level in patients where this is a concern, such as fire or smoke inhalation victims.Ĭyanide concentration levels may be obtained however, the results are not available in time to be clinically useful. An increased anion gap metabolic acidosis is expected in patients with cyanide poisoning. Also, consider obtaining acetaminophen and salicylate levels to rule out co-ingestions. All patients presenting from a structural fire are to be presumed to have cyanide toxicity. Plasma lactate also may be obtained, and a level greater than eight mmol/L is 94% sensitive and 70% specific for significant cyanide toxicity. Labs that are pertinent to the initial evaluation in a patient with cyanide poisoning are complete blood count, electrolytes, urinalysis, urine tox screen, arterial blood gas, carboxyhemoglobin level (if in a fire), chest x-ray, and EKG. Patients with cyanide poisoning will not be cyanotic but will have a cherry red color due to excess oxygen in the bloodstream.

ANTIDOTE TO SKIN

It is important to note that a patient's skin can be a normal or slightly ashen appearance despite tissue hypoxia.

Hypotension and bradycardia are common in cyanide poisoning. Early respiratory and cardiovascular findings include tachypnea and tachycardia, while late findings include apnea, hypotension, and cardiac arrhythmia. These are due to tissue hypoxia, and seizures and coma can develop as it progresses to an altered level of consciousness. Some early central nervous system findings are headache, dizziness, confusion, and mydriasis. The clinical manifestations can be divided into early and late categories. If the hydrogen cyanide was inhaled, the victim might detect a bitter, almond odor, which is discernible by approximately 60% of the population. The patient can present with symptoms as quickly as one minute after inhalation and within a few minutes of cyanide ingestion.

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