title: Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote?
abstract: Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.
authors.affiliation: University of Massachusetts, 55 Lake Ave North, Worcester, MA, 01605, USA. eike.blohm@umassmemorial.org.
authors.forename: Eike
authors.initials: E
authors.lastname: Hamad
authors.affiliation: Department of Emergency Medicine, University of Massachusetts, 55 Lake Ave North, Worcester, MA, 01605, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Babu
authors.affiliation: Department of Emergency Medicine and Medical Toxicology, University of Colorado School of Medicine, Aurora, CO, USA.|Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, USA.|CBRNE Enhanced Response Force Package (CERFP), Colorado Air National Guard, Buckley AFB, Aurora, CO, USA.
authors.forename: Vikhyat S
authors.initials: VS
authors.lastname: Bebarta
mesh_terms: D000046:Academic Medical Centers; D000465:Algorithms; D000931:Antidotes / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy / Q000009:adverse effects; D003663:Decision Trees; D055416:Evidence-Based Emergency Medicine; D005257:Fellowships and Scholarships; D005260:Female; D005739:Gas Poisoning / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D006856:Hydrogen Cyanide / Q000037:antagonists & inhibitors / Q000633:toxicity*; D006879:Hydroxocobalamin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008404:Massachusetts; D000067716:Point-of-Care Testing; D015208:Smoke Inhalation Injury / Q000097:blood / Q000150:complications* / Q000628:therapy; D014116:Toxicology / Q000193:education; D000078329:Workforce
chemical_list: D000931:Antidotes; D015415:Biomarkers; D006856:Hydrogen Cyanide; D006879:Hydroxocobalamin
keywords: Cyanide; Fire; Hydroxocobalamin; Smoke inhalation; Sodium thiosulfate
references.citation: Prehosp Disaster Med. 2006 Mar-Apr;21(2):s49-55
references.pmid: 16771012
references.citation: Fundam Appl Toxicol. 1985 Dec;5(6 Pt 2):S150-9
references.pmid: 2868959
references.citation: Am J Ther. 2014 Jul-Aug;21(4):244-9
references.pmid: 23689094
references.citation: Eur J Emerg Med. 2013 Feb;20(1):2-9
references.pmid: 22828651
references.citation: Am J Emerg Med. 1995 Sep;13(5):524-8
references.pmid: 7662055
references.citation: Pediatr Crit Care Med. 2006 Jan;7(1):79-82
references.pmid: 16395080
references.citation: Anesth Analg. 1999 Dec;89(6):1448-52
references.pmid: 10589625
references.citation: Crit Care Med. 2002 Sep;30(9):2044-50
references.pmid: 12352039
references.citation: Clin Toxicol (Phila). 2012 Sep;50(8):759-63
references.pmid: 22882141
references.citation: Ther Umsch. 2009 May;66(5):387-97
references.pmid: 19401990
references.citation: Toxicology. 1986 Aug;40(2):121-9
references.pmid: 3726889
references.citation: J Emerg Med. 2010 May;38(4):467-76
references.pmid: 20185266
references.citation: J Emerg Med. 1988 Sep-Oct;6(5):401-4
references.pmid: 3147294
references.citation: J Emerg Nurs. 2006 Aug;32(4 Suppl):S12-8
references.pmid: 16860672
references.citation: Anesth Analg. 1997 May;84(5):1121-6
references.pmid: 9141943
references.citation: J Toxicol Clin Exp. 1989 Jan-Feb;9(1):3-9
references.pmid: 2746547
references.citation: Intensive Care Med. 1997 Dec;23 (12 ):1286
references.pmid: 9470088
references.citation: BMJ. 1996 Jan 6;312(7022):26-7
references.pmid: 8555853
references.citation: Ann Emerg Med. 2007 Jun;49(6):794-801, 801.e1-2
references.pmid: 17481777
references.citation: Ann Emerg Med. 2008 Mar;51(3):338-9
references.pmid: 18282534
references.citation: N Engl J Med. 1991 Dec 19;325(25):1761-6
references.pmid: 1944484
references.citation: Toxicol Appl Pharmacol. 1991 Jul;109 (3):412-20
references.pmid: 1853342
references.citation: Prehosp Disaster Med. 2011 Oct;26(5):374-82
references.pmid: 22336184
references.citation: Ann Emerg Med. 2007 Jun;49(6):806-13
references.pmid: 17098327
references.citation: Ann Emerg Med. 1993 Sep;22(9):1413-8
references.pmid: 8363114
references.citation: Intensive Care Med. 2003 Aug;29(8):1372-5
references.pmid: 12856122
references.citation: Eur J Emerg Med. 2005 Oct;12(5):257-8
references.pmid: 16175068
references.citation: J Chin Med Assoc. 2003 Apr;66(4):193-203
references.pmid: 12854870
references.citation: Anaesthesist. 2013 Aug;62(8):609-16
references.pmid: 23917894
references.citation: Ann Emerg Med. 2010 Apr;55(4):345-51
references.pmid: 19944487
references.citation: Ann Pharm Fr. 2005 Mar;63(2):154-61
references.pmid: 15976683
references.citation: Am J Obstet Gynecol. 1977 Sep 1;129(1):69-103
references.pmid: 561541
references.citation: Clin Toxicol (Phila). 2006;44 Suppl 1:37-44
references.pmid: 16990192
references.citation: JEMS. 2004 Aug;29(8):suppl 18-21
references.pmid: 15362233
references.citation: Hum Exp Toxicol. 2007 Mar;26(3):191-201
references.pmid: 17439922
references.citation: Clin Nephrol. 2013 Apr;79(4):323-5
references.pmid: 23537683
references.citation: J Toxicol Clin Toxicol. 2004;42(6):855-63
references.pmid: 15533025
references.citation: Acta Physiol Scand. 2001 Jan;171(1):9-16
references.pmid: 11350258
references.citation: Environ Health Perspect. 1975 Jun;11:163-89
references.pmid: 170077
references.citation: Am J Med. 1992 Nov;93(5):582-3
references.pmid: 1442864