cyanide

A 13-year-old male is brought in by EMS for altered mental status after being found in a house fire. The fire department found burned couches in the house with melted plastic covering. His vital signs include BP 78/40, HR 155, T 99.9 Oral, RR 40, SpO2 92% on 15L NRB. He is somnolent but withdraws to pain. He has soot in his nares with carbonaceous sputum, and auscultation reveals rhonchorous and wheezing breath sounds bilaterally. Point of care VBG demonstrates a lactate of 16. What’s the next step in your evaluation and treatment?

How does cyanide toxicity present, and what’s the best therapy?

An 18-year-old male has been found unresponsive in a house fire with severe burns. VS in the field include T 37.5C, BP 144/77, HR 110, RR 15, Pulse Ox 98% on RA. You have minutes to prepare your team to care for this patient. What’s your next step in evaluation and treatment?