Jan TrojanowskiPGY-5 Emerg UWO
Goals and Objectives
Case presentationManagement principlesNew(ish) developmentsExpert recommendations
Case
Plastics factory fire22 y.o. female workerNo burns, no injuriesSoot in mouthGCS 3??? Seizure
Case cont’d
IV, intubated by EMS96/50, 36.7oC, HR = 45, RR = 26, 96%Skin = cherry redNurse says…
Smells like burnt
almonds in here!!
Case cont’d
Investigations pH 6.95pO2 70pCO2 60HCO3 4AG 26Lactate >10CO 29%
Doctor, do
something!!
Add it all up…
Plastics fireCOMA
?SeizureLactate >10
Smells like almonds=
CYANIDE
Cyanide
cyanide
Cyanide
Cyanide Antidote Kit(aka Lilly Kit)• Components?• Amyl nitrite pearls• Sodium nitrite• Sodium thiosulfate
Downsides?
Another silver bullet?
Hydroxocobalamin
Adult: 2.5g in 100cc NS x2
Cyanide
hydroxocobolamin
Cyanocobalamin
Hydroxocobalamin
Interferes with colorimetric tests (ie. HGB, Cr, glu, albumin, INR/PTT, CK, etc.) Hypertension
Hydroxocobalamin notes
Fire brigades in ParisPrehospital/EMS
Lilly kit (no longer made)Cyanide kit
Special access$400
HydroxocobalaminSpecial access$800
Ann Emerg Med. 2009 Sep;54(3):386-394
Cyanide OPCC stats
2009 (to date)52 519 calls8 presumed cyanide exposures (2 deaths)No clinical ability to measure CN levels
????
