- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Part 15.1 Principles of management
- Part 15.2 Management of specific poisons
- Chapter 317 Management of salicylate poisoning
- Chapter 318 Management of acetaminophen (paracetamol) poisoning
- Chapter 319 Management of opioid poisoning
- Chapter 320 Management of benzodiazepine poisoning
- Chapter 321 Management of tricyclic antidepressant poisoning
- Chapter 322 Management of poisoning by amphetamine or ecstasy
- Chapter 323 Management of digoxin poisoning
- Chapter 324 Management of cocaine poisoning
- Chapter 325 Management of β-blocker and calcium channel blocker poisoning
- Chapter 326 Management of cyanide poisoning
- Chapter 327 Management of alcohol poisoning
- Chapter 328 Management of carbon monoxide poisoning
- Chapter 329 Management of corrosive poisoning
- Chapter 330 Management of pesticide and agricultural chemical poisoning
- Chapter 331 Management of radiation poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
Management of cyanide poisoning
- Chapter:
- Management of cyanide poisoning
- Author(s):
Stephen W. Borron
- DOI:
- 10.1093/med/9780199600830.003.0326
Acute cyanide poisoning poses vital diagnostic and therapeutic challenges for emergency physicians and intensivists. While it presents certain unique clinical features, cyanide poisoning may be confused with other entities. Definitive, contemporaneous diagnosis at the bedside is impossible in most hospitals. A thorough anamnesis, rapid physical assessment, and evaluation of key laboratory indicators often point the clinician in the right direction. Smoke inhalation from structure fires represents the most frequent source of cyanide poisoning. Symptom onset may be gradual in the case of skin exposures to cyanide or ingestion of compounds that are metabolized to cyanide. However, acute cyanide poisoning presents as a syndrome of rapidly evolving and deteriorating vital signs, profound neurological and cardiovascular dysfunction, and if therapeutic interventions are not timely and adapted, death. There is little time for diagnostic testing: one must act! The sine qua non of treatment is excellent supportive care, with aggressive airway management, support of blood pressure, and correction of acidosis. Treatment of acidosis is particularly relevant in the case of cyanide. Rapid administration of specific cyanide antidotes may be lifesaving. While geographic variations exist in antidote availability, most commercially available antidotes have been demonstrated to be effective. Hydroxocobalamin and sodium thiosulphate, both safe in the setting of smoke inhalation, offer the highest therapeutic index, a critical consideration when the diagnosis is uncertain.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Part 15.1 Principles of management
- Part 15.2 Management of specific poisons
- Chapter 317 Management of salicylate poisoning
- Chapter 318 Management of acetaminophen (paracetamol) poisoning
- Chapter 319 Management of opioid poisoning
- Chapter 320 Management of benzodiazepine poisoning
- Chapter 321 Management of tricyclic antidepressant poisoning
- Chapter 322 Management of poisoning by amphetamine or ecstasy
- Chapter 323 Management of digoxin poisoning
- Chapter 324 Management of cocaine poisoning
- Chapter 325 Management of β-blocker and calcium channel blocker poisoning
- Chapter 326 Management of cyanide poisoning
- Chapter 327 Management of alcohol poisoning
- Chapter 328 Management of carbon monoxide poisoning
- Chapter 329 Management of corrosive poisoning
- Chapter 330 Management of pesticide and agricultural chemical poisoning
- Chapter 331 Management of radiation poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care