Adult Cyanide Poisoning

Question 1

Adult Cyanide Poisoning - Treatment Criteria?

Answer 1

Known or suspected risk factors AND 1 or more:
GCS <8
Systolic BP <90 mmHg

Known or suspected risk factors, GCS <14 AND when 1 or more:
Chest pain and/or ischemic ECG changes
Dyspnea and/or pulmonary edema
Respiratory rate <12

Question 2

Adult Cyanide Poisoning - Early S/S of poisoning?

Answer 2

tachypnea
tachycardia
palpitations
chest pain/tightness
headache
dizziness
nausea/vomiting
mydriasis

Question 3

Adult Cyanide Poisoning - Field Diagnosis?

Answer 3

Based on presence of risk factors and presenting signs and symptoms.
A patient exposed to smoke with soot around mouth and nose should be assumed to be exposed

Question 4

Adult Cyanide Poisoning - Supportive management?

Answer 4

Remove from environment
100% oxygen regardless of SpO2
Transport

Question 5

Adult Cyanide Poisoning - Cardiac Arrest special treament?

Answer 5

Hydroxocobalamin 5 g SIVP/IO - IRP required

Question 6

Adult Cyanide Poisoning - Cardiac Arrest refractory to initial Hydroxocobalamin?

Answer 6

Mandatory OLMC Hydroxocomalamin 5 g SIVP/IO total max of 10 g if clinical response to initial treatment has not improved

Question 7

Adult Cyanide Poisoning - S/S meet treatment requirements?

Answer 7

5 g IV/IO over 15 minutes

Question 8

Adult Cyanide Poisoning - Refractory symptoms to S/S requireing Hydroxocobalamin?

Answer 8

Mandatory OLMC - 5 g IV/IO over 15 min to 2 hours to total max of 10 g, if clinical response to initial treatment has not improved

Question 9

Adult Cyanide Poisoning - Hydroxocobalamin Indications?

Answer 9

Known or suspected cyanide poisoning

Question 10

Adult Cyanide Poisoning - Hydroxocobalamin Dose?

Answer 10

Cardiac arrest or actively seizing patients - 5 g SIVP/IO

S/S meet treatment criteria - 5 g IV/IO over 15 min

Question 11

Adult Cyanide Poisoning - Hydroxocobalamin Contraindications?

Answer 11

Hypersensitivity to hydroxocobalamin, cyanocobalamin (vitamin B12), cobalt or excipients

Question 12

Adult Cyanide Poisoning - Hydroxocobalamin Precautions?

Answer 12

Requires its own IV line

Can cause a rash resembling anaphylaxis - rely on other signs prior to treatment

Question 13

Adult Cyanide Poisoning - Hydroxocobalamin Administration?

Answer 13

Reconstitute 5 g vial with 200 mL normal saline
DO NOT shake to avoid foaming. Rock or invert vial for at least 30 - 60 seconds
Use the IV line provided in the kit as it contains a filter to remove any particles not visible due to the solution’s dark red color
In cases where administration is by IO or small volumes of the medication are required, a stopcock and syringe should be used