HYPERBARIC EVALUATION AND TREATMENT OF CYANIDE TOXICITY

Course overview

CYANIDE TOXICITY OCCURS COMMONLY IN PATIENTS WITH SMOKE INHALATION WHO HAVE BEEN REMOVED FROM BURNING STRUCTURES. CYANIDE FORMS AS A RESULT OF INCOMPLETE COMBUSTION OF MATERIALS CONTAINING NITROGEN (PLASTICS, VINYL, ACRYLICS, NYLON, NEOPRENE, RUBBER, INSULATION). PATIENTS PRESENTING FROM STRUCTURE FIRES WITH CARBON MONOXIDE POISONING SHOULD BE ASSUMED TO HAVE BEEN EXPOSED TO TOXIC LEVELS OF CYANIDE AS WELL SINCE MOST MODERN BUILDINGS CONTAIN THESE MATERIALS. OTHER SOURCES INCLUDE WORKPLACE EXPOSURE, PROLONGED ADMINISTRATION OF SODIUM NITROPRUSSIDE, INSECTICIDES, METALWORKING, BITTER ALMONDS, AND THE SEEDS OF SOME FRUITS SUCH AS APRICOTS. HYDROGEN CYANIDE HAS ALSO BEEN USED IN CHEMICAL WARFARE (GAS CHAMBERS IN GERMAN CONCENTRATION CAMPS IN WORLD WAR II) BECAUSE INHALATION LEADS QUICKLY TO DEATH. THIS ACTIVITY DESCRIBES THE PATHOPHYSIOLOGY OF CYANIDE POISONING AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN THE MANAGEMENT OF THESE PATIENTS.