University:
Boston University
Course:
CAS CH 524 | Chemical Biology Laboratory
Academic year:

2022
Views:

330

Pages:

13
Author:

paproszekmca5

What to do when you suspect Cyanide Poisoning 1. Remove patient to non–contaminated area • All occupants should leave the area to noncontaminated areas, in order to protect those that are not yet affected • Take cyanide antidote package 2. Call 911 In case of emergency, call 911 Report an emergency involving the use of cyanide Identify yourself Identify the type of emergency (spill/exposure/name of chemicals involved) Specify the location (address, room, building) Provide details on exposure victims ( #, route of exposure, conscious, breathing) Other information (when it occurred, how long the victims have been unconscious) Provide your phone number 3. Maintaining an adequate airway is mandatory • Establish an airway • If the patient has stopped breathing administer artificial respiration with non–rebreather respirator or a manual bag with pure O2 • No mouth to mouth resuscitation unless no other choice, especially if ingestion is route of exposure • Ventilate with 100% Oxygen if available 4. Amyl Nitrite (in package) • While administering artificial respiration, have an assistant break the ampoule of amyl nitrite, one at a time, in a handkerchief or gauze sponge and holds it in front of the the patients mouth for 15 seconds, followed by a rest for 15 seconds. Repeat – Persistent use without a 15 second rest may prevent adequate oxygenation – Each ampoule last 2–3 minutes Amyl Nitrite – Step 4 continued • If the victim is receiving respiratory support, place the ampoules in the face mask or port access to the endotracheal tube • Amyl Nitrite Produces cyanide scavenging methemoglobin similar to sodium nitrite 5. Decontamination Remove clothes that are contaminated by cyanide (skin absorption) including socks and shoes • Wash contaminated areas with water • Victim’s vomits may contain cyanide • Wash immediately if vomit gets on skin 6. Keep Patient Warm Cyanide Antidote Package (presumes medical personnel have arrived) Step 1: Initiate 100% Oxygen while preparing for intravenous administration Step 2: Simultaneously with oxygen, administer Amyl Nitrite Inhalant for 15 to 30 seconds every 2 or 3 minutes Step 3: Discontinue administration of Amyl Nitrite and inject Sodium Nitrite intravenously 300 mg at the rate of 2.5 to 5 mL/minute Cyanide Antidote Package (presumes medical personnel has arrived) Step 4: Immediately thereafter inject 12.5 g of Sodium Thiosulfate The same needle and vein may be used for step 3 and step 4 Step 5: If the poison was taken by mouth, gastric lavage should be performed as soon as possible, but this should not delay the treatments outlined above. Lavage may be done concurrently by a third person (physician/nurse) Monitoring Patient • Patient should be watched closely for 24–48 hours. If signs of poisoning reappear, injection of both sodium nitrate and sodium thiosulfate should be repeated, but each at half the original dose • Even it the patient appears perfectly well the medication may be given for prophylactic purposes 2 hours after the initial dose Warning • Sodium Nitrite and Amyl Nitrite in excessive doses induce dangerous methemoglobinemia and can cause death • The amounts in a single Cyanide Antidote Package are not excessive for an adult according to the manufacturer • Signs of methemoglobin are blue skin and mucous membranes, vomiting, shock, coma. 1% methyline blue solution should be given IV (1-2 mg/kg of body weight over 5-10 minutes, repeated in 1 hour if necessary Laboratory Tests • Arterial and venous blood gases • Pulse Oximetry • Red blood cell and plasma cyanide concentrations • Methemoglobin concentration – Greater than 10% indicates that further nitrite therapy is not indicated Diagnosis • • • • • Based on History of Exposure Rapidly progressive symptoms and signs Elevated venous oxygen saturation Bitter almond odor of hydrogen cyanide Whole blood levels > .5 –1 mg/L are toxic