injuries poisoning
Systemic Asphyxiant Chemical Warfare Agents
Treatment of Systemic Asphyxiant Chemical Injuries
Airway support and 100% oxygen For cyanide, specific antidotes Attention should be given to airway, breathing, and circulation. Water with or without soap suffices for skin decontamination; patients exposed only to vapor or gas usually do not require decontamination. Cyanide casualtiesrequire prompt antidotal therapy with inhaled amyl nitrite 0.2 mL (1 ampule) for 30 seconds of each minute; 3% sodium nitrite 10 mL at 2.5 to 5 mL/minute IV (in children, 10 mg/kg), then 25%sodium thiosulfate25 to 50 mL at 2.5 to 5 mL/minute IV. Where available,hydroxocobalamin5 to 10 g IV may be given instead. Antidotes may be effective even in apneic patients. In the absence of antidotes, ventilation and administration of 100% oxygen may be life-saving. However, unprotected mouth-to-mouth resuscitation may expose the rescuer to cyanide in the patient’s breath. Cyanide casualties resulting from smoke inhalation may also have carbon monoxide poisoning; previous concerns about administering nitrites in this situation are probably overstated. Hyperbaric oxygen has not been proven to improve outcomes in patients poisoned with cyanide. , and hyperbaric oxygen (as are used in cyanide) are of no benefit. However, intravenous bicarbonate plus glucose reduced lethality and coma duration in a rat model and may be tried in humans ( Treatment reference ). Guidotti TL: Hydrogen sulfide: Advances in understanding human toxicity.Int J Toxicol, 29(6):569-581, 2010. doi: 10.1177/1091581810384882 The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, or the US Government. 