Cyanide poisoning of a woman- how to treat?
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A 19-year-old woman was transported to the Emergency Department (ED) by ambulance after suddenly collapsing at home. The patient’s boyfriend, who complained of nausea, accompanied the ambulance to the ED. The patient had been in excellent health. On the day of admission, according to the boyfriend, he and the patient were in their apartment when the patient reportedly drank from an open seltzer bottle found in the refrigerator. Immediately after drinking from this bottle, the patient began to complain of nausea and to retch. The patient’s friend reported that he attempted to taste the seltzer but the patient knocked the bottle from his hand before she collapsed to the floor. The Emergency Medical Service was called. On arrival of an Advanced Life Support (ALS) team, the patient was noted to be unresponsive and apneic. Systolic blood pressure was 110 mmHg by palpation, and pulse was 110 beats per minute. No unusual odors or other findings were noted in the patient’s home. She was intubated and transported to the ED along with the empty seltzer bottle.
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@papan The treatment of cyanide poisoning involves removing the patient from the source of the exposure, administering 100% oxygen, cardiorespiratory support as needed, and an antidote. If the victim’s clothes are contaminated with a cyanide-containing compound, they should be removed. Administration of ipecac is contraindicated because of the possibility of seizures and rapid deterioration of mental status. Activated charcoal adsorbs cyanide poorly, but when administered in the recommended dosage, it is still capable of adsorbing a quantity of cyanide well above the expected lethal dose. Since charcoal may also adsorb other unknown co-ingested substances, its administration in the setting of suspected cyanide poisoning is recommended