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27 Cards in this Set
- Front
- Back
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When is cyanide poisonig most likely to occur |
When a patient inhales burning plastics |
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How might cyanide poisoning occur other than house fire |
Ingestion of cyanide containing compounds - U/K examples, apparently apple seeds contain cyanide Inhaled industrial gases containing cyanide - metal polishing |
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What is main cause of harm in cyanide poisoning |
Cyanide binds to the ferric ion of cytochrome c oxidase and causes cellular metabolism to fail due to the cells inability to use inspired oxygen |
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(You have been confused by cyanide poisoning and carbon monoxide poisoning before) TorF increasing inspired oxygen levels is beneficial in cyanide poisoning. |
F - as cellular metabolism is inhibited the patient will be unable to use the oxygen |
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If aerobic respiration is inhibited what is one of the likely effects of this |
Lactic (metabolic) acidosis |
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What are main clinical features of cyanide poisoning |
Reduced GCS (altered mntal status follwed y coma), SOB, hypotension, CV collapse incl bradycardias. Eventually seizures and death |
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How are you most likely to diagnose cyanisde poisoning |
Clinical suspicion, Hx, presentaion on scene |
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Hw does hydroxycobalamin work? |
Binds to cyanide and rapidly reversing effects on cell metabolsim |
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What other antidotes exist for cyanide and why dont HEMS use them? |
Sodium nitrate sodium thiosulphate Dicobalt edatate Cyanokit is less toxic and easier to use |
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Where is cyanokit kept |
Green barrel bag in the boot of the aircraft or the boot of the cars |
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Where are additional cyaokits kept |
On the helipad |
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What are the indicattions for cyanokit |
The presence of a strong clinica suspicion of smoke inhalation, know or suspected cyanide ingestion or inhalation: Reduced GCS or cardiovascular instability (SBP <90, dysrhythmias, ST/T changes) or cardiac arrest (where other causes of shock have been excluded) |
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TorF hydroxycobalamin can be given to anyone |
T - all ages and during pregnancy/breastfeeding |
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What is trhe presentaion of cyanokit |
2 x 2.5g of freeze dried hydroxycobalamin in 250ml bottles 2 x sterile transfer kits |
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How is reconstitution achieved |
Using the sterile transfer kit add 100ml normal saline to the powder and rock/invert gently to dissolve |
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What colour is the fluid after reconstitution |
Red/orange |
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How much fluid goes into each bottle |
100mls |
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What is the sterile transfer kit |
(Probably) a double spike - one soike into the bag of saline, one into the bottle |
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What gets used to administer the solution to the patient |
The IV giving set in the kit |
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What dose of hydroxycobalamin is given to adults |
5g (whole kit) |
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What can be considered for multiple smoke inhalation patients? What needs to be in the handover of these patients |
Splitting the dose and giving 2.5g to each That the reduced dose has been given and that they need to complete the two doses |
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whats the dose in paeds |
70mg/kg |
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What is the concentration of reconstituted hydroxycobalamin and what, therefore is the volume given per kg |
25mg/ml
Just under 3ml/kg |
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TorF there are dangerous sde effects of hydroxycobalmin |
F - this is an entirely safe drug if administered correctly |
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What potentially alarming side effects does cyanokit have |
Pink/red discolouration of the skin and muous membranes and red urine for days after administration |
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why is there a red discolouratuion in the urine |
Hydroxycobalamin binds to cyanide and forms cyanocobalmin - this and hydroxycobalamin is excreted via the kidneys in urine and is a dark red colour |
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What should be explicitly handed over to trauma TLs when cyanokit has been used other than that you have used it? |
That hydroxycobalamin and thiosulphate must not be mixed in the same infusion |
