Pediatric Cyanide Poisoning

Question 1

Pediatric Cyanide Poisoning - Known or suspected risk factors?

Answer 1

Exposure to product of combustion - smoke
Cyanide ingestion
Exposure to cyanide containing products

Question 2

Pediatric Cyanide Poisoning - Prior to pt contact?

Answer 2

Consider CFD, IRP and PADIS

Ensure proper PPE

Question 3

Pediatric Cyanide Poisoning - Initial actions?

Answer 3

Remove pt from source
Decontamination
Obtain cyanide kits (2 preferred)
Manage airway
O2 prn
Vascular access
ECG

Question 4

Pediatric Cyanide Poisoning - Criteria for Hydroxocobalamin?

Answer 4

Known or suspected exposure and GCS <8 or BP <70+(2xage)
or
GCS <14 and chest pain or ischemic ECG changes or dyspnea or pulmonary edema or RR < 12

Question 5

Pediatric Cyanide Poisoning - Cardiac arrest or actively seizing?

Answer 5

Hydroxocobalamin 70 mg/kg SIVP single max of 5 g

If no response mandatory OLMC for repeat dose with total max of 10 g

Question 6

Pediatric Cyanide Poisoning - Cyanide poisoning criteria met?

Answer 6

Hydroxocobalamin 70 mg/kg IV/IO single max of 5 g over 15 min
If no effect mandatory OLMC for repeat dose with total max of 10 g over 15 min - 2 hr

Question 7

Pediatric Cyanide Poisoning - Minimum PPE for this patient group?

Answer 7

Airborne precautions - N95, gloves, glasses, gown

Question 8

Pediatric Cyanide Poisoning - Decontamination for patients contamination by airborne particulate and inhalation?

Answer 8

Remove all clothing

Question 9

Pediatric Cyanide Poisoning - Decontamination for For patients suspected of contamination with liquids or solids?

Answer 9

Remove all clothing
Remove skin contaminants by showering and washing at the hospital
Remove solid particles by gently brushing them off

Question 10

Pediatric Cyanide Poisoning - Hydroxocobalamin indications?

Answer 10

Known or suspected cyanide poisoning

Question 11

Pediatric Cyanide Poisoning - Hydroxocobalamin dose

Answer 11

Cardiac arrest or actively seizing patients:
70 mg/kg SIVP/IO to a single max of 5 g

All other patients
70 mg/kg IV/IO over 15 min to a single max of 5 g

Repeat mandatory OLMC – 70 mg/kg SIVP/IO to a total max of 10 g

Question 12

Pediatric Cyanide Poisoning - Hydroxocobalamin EMS contraindications

Answer 12

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

Question 13

Pediatric Cyanide Poisoning - Hydroxocobalamin precautions

Answer 13

Red urine and red discoloration of the skin and mucous membranes often occur
DO NOT mix or infuse hydroxocobalamin with other medications or blood products, use a separate line as it is not compatible
Patients may develop a rashthat mimics an anaphylactoid reactionlook for other signs prior to further treatment