Educational Objectives:Īfter the completion of this simulation, participants will have learned how to: 1) identify clues of smoke inhalation based on a physical examination 2) identify smoke inhalation-induced airway compromise and perform definitive management 3) create a differential diagnosis for victims of fire cyanide poisoning, carbon monoxide, and carbon dioxide 4) appropriately treat cyanide poisoning 5) demonstrate the importance of preemptively treating for cyanide poisoning 6) perform an initial physical examination and identify physical marks suggesting the patient is a fire and smoke inhalation victim and 7) familiarize themselves with the Cyanokit and treatment with hydroxocobalamin.
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Therefore, the goal of this simulation case is to expose the emergency providers to cyanide poisoning and educate emergency providers about the critical steps of how to approach, diagnose, and treat cyanide toxicity. We understand the importance of knowing how to treat fire victims. 2 Rather, the emergency room personnel must begin treatment immediately upon recognizing that toxic smoke inhalation may have occurred.
Unfortunately, due to the limited amount of time the human body can sustain anaerobic metabolism and tissue hypoxia, blood test results are not available in time to be clinically applicable. 2Acute cyanide toxicity can become fatal within minutes however, a prompt diagnosis and treatment can be lifesaving. It is estimated that 35% of all fire victims have toxic levels of cyanide upon arrival to the emergency room. The challenge in treating these patients is for the healthcare team to know the differential diagnoses, prioritize airway, breathing and circulation, and to empirically treat the patient as if they have a confirmed exposure. 5 The respiratory distress and metabolic compromise will be acutely more fatal than the obvious external injuries and burns. These toxic gasses will cause severe tissue hypoxia without significant vital sign changes. People who are trapped within a burning structure are exposed to carbon monoxide, carbon dioxide, and cyanide from the combustion of contents within the building. They will likely have obvious external thermal burns and traumatic injuries however, it is important for emergency personnel to recognize the respiratory distress and metabolic derangements that are most likely occurring due to toxic gas inhalation. 4įire victims often present to the emergency department critically ill. 4 Each of the antidotes works by binding with the highly reactive cyanide, neutralizing the compound, and converting it into a water-soluble product that will be cleared through renal excretion. Cyanide toxicity must be treated with an antidote – sodium thiosulfate, sodium nitrite, and hydroxocobalamin. However, symptoms of cyanide toxicity cannot be treated with supplemental oxygen as carbon monoxide and carbon dioxide are. 1These are similar to those of carbon monoxide and carbon dioxide inhalation. Symptoms of cyanide toxicity include headache, nausea, shortness of breath, and altered mental status. Ultimately, the body will suffer cardiorespiratory arrest. 3 The human body cannot sustain itself with the lack of oxygen and anaerobic metabolism for a prolonged period of time. Anaerobic metabolism results in the production of lactic acid, which causes metabolic acidosis. 2 The inability of the cell to use oxygen forces cells from aerobic metabolism into anaerobic metabolism. When cyanide enters the body via inhalation, it blocks the cells from utilizing oxygen by binding to the cytochrome oxidase in the mitochondria. Hydrogen cyanide is especially dangerous to humans because the gaseous form reacts quickly upon inhalation. 1 As the use of contemporary nitrogen-containing synthetic polymers has expanded, the possibility of cyanide toxicity has become increasingly common and severe. However, modern synthetic materials such as plastics, papers, textiles, and machinery can release a much greater concentration of hydrogen cyanide when exposed to high temperatures.
1 The trace amounts of cyanide found within organic materials is of little concern because its high reactivity causes it to be metabolized rapidly and create other compounds. It is present within many different types of plants and fruits including apricots, apples, peaches, lima beans, and cassava plants but is harmless. Introduction :Ĭyanide has an almond scent and is a naturally occurring compound. The goal of this simulation is to educate emergency medicine students, residents, attending physicians, and mid-level practitioners to recognize, diagnose, and manage acute cyanide toxicity.
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