What is included in prehospital care for cyanide toxicity?

Updated: May 30, 2020
  • Author: Inna Leybell, MD; Chief Editor: Michael A Miller, MD  more...
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Answer

Appropriate prehospital measures may include the following [7, 8] :

  • Rescue from the cyanide source (on the assumption that rescuers have the highest level of respiratory protection [level A])

  • Removal of contaminated clothing and decontamination of the skin as required with soap and water

  • Administration of high-flow oxygen, airway management, and ventilatory support as required

  • Establishment of intravenous (IV) access

  • Continuous cardiac monitoring

  • Advanced cardiac life support (ACLS) measures as indicated for dysrhythmias

Aggressive airway management with delivery of 100% oxygen can be lifesaving. (Although theoretically useless, supportive care with administration of oxygen alone has proven effective in a number of poisonings.) It can also treat concomitant carbon monoxide exposure, pending measurement of blood levels.

Administer cyanide antidotes as soon as possible. [29, 26, 27] While not carried by all emergency medical technicians, some first responders do have protocols to administer hydroxocobalamin in the field. As a temporizing measure, amyl nitrite ampules can be crushed and their contents poured onto a gauze pad and placed in front of the patient's mouth, if the patient is breathing spontaneously, or ventilated into an apneic patient using a bag-valve-mask.


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