Journal
EUROPEAN JOURNAL OF EMERGENCY MEDICINE
Volume 20, Issue 1, Pages 2-9Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MEJ.0b013e328357170b
Keywords
algorithm; cyanide inhalation; cyanide poisoning; guidelines; hydrogen cyanide; hydroxocobalamin; nitrites; smoke inhalation; smoke inhalation injury; thiosulphate
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Smoke inhalation is a common cause of cyanide poisoning during fires, resulting in injury and even death. In many cases of smoke inhalation, cyanide has increasingly been recognized as a significant toxicant. The diagnosis of cyanide poisoning remains very difficult, and failure to recognize it may result in inadequate or inappropriate treatment. Findings suggesting cyanide toxicity include the following: (a) a history of enclosed-space fire; (b) any alteration in the level of consciousness; (c) any cardiovascular changes (particularly inexplicable hypotension); and (d) elevated plasma lactate. The feasibility and safety of empiric treatment with hydroxocobalamin for fire smoke victims have been reported in the literature. On the basis of a literature review and a panel discussion, a group of European experts has proposed emergency management protocols for cyanide toxicity in fire smoke victims. European Journal of Emergency Medicine 20:2-9 (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. European Journal of Emergency Medicine 2013,20:2-9
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