The burnt almond smell and noncyanotic dyspnea is characteristic of cyanid poisoning. Cyanide poisoning is treated with nitrites because nitrites oxidize hemoglobin to form methamoglobin which binds cyanide, allowing less toxicity. Thiosulfate is often added to increase renal excretion as thiocyanate. Cyanide toxicity may also be treated with hydroxycobalmin, which binds cyanide.
FA2020 p667 has differentiation of cyanide from CO poisoning.
drippinranchis there a circumstance where you would treat cyanide poisoning first with hyperbaric oxygen before hydroxy/nitrates/thiosulfate?+1
prosopagnosiaIf the patient had concomitant carbon monoxide poisoning, then I think the hyperbaric oxygen would help. But in order to reverse cyanide poisoning, hyperbaric oxygen will not help because the cells are unable to use oxygen since the cyanide directly inhibits oxidative phosphorylation. +1
i_hate_it_hereAnother thing to know about this is that unlike with CO poisoning, your O2 saturation of hemoglobin, total O2 content, and oxygen-hemoglobin dissociation curve would all be normal. FA2020 pg: 666+3
chaosawaitsIn reality, I believe, 100% oxygen would be provided in order to maximize the amount of oxygen dissolved in the plasma which, although small, can make a difference between life and death. However, I believe hyperbaric oxygen is very unlikely to be used rather than just a NRB mask and of course you'd still apply amyl nitrite because applying oxygen is going to do absolutely nothing for the hemoglobin problem.+
submitted by โcassdawg(1780)
The burnt almond smell and noncyanotic dyspnea is characteristic of cyanid poisoning. Cyanide poisoning is treated with nitrites because nitrites oxidize hemoglobin to form methamoglobin which binds cyanide, allowing less toxicity. Thiosulfate is often added to increase renal excretion as thiocyanate. Cyanide toxicity may also be treated with hydroxycobalmin, which binds cyanide.
FA2020 p667 has differentiation of cyanide from CO poisoning.