Cellular Asphyxiant, WMD Blood Agent, Hydrogen Cyanide, Sodium Cyanide, Cyanogen Chloride, Potassium Cyanide, Hydrogen Sulfide, Sewer Gas

Home , Blood agent, Cyanogen, Cyanogen chloride, Potassium cyanide, Sodium cyanide

Xenobiotic: Cellular asphyxiant, WMD Blood Agent, Hydrogen cyanide, Sodium Cyanide, Cyanogen chloride, Potassium Cyanide, Hydrogen Sulfide, Sewer Gas

Expected states of matter: Gas, Possibly liquid at colder temperatures

Purpose: Cyanides have a toxic mechanism of action at the A3 cytochrome of the mitochondria that inhibits the last step of the electron transport chain of cellular respiration. They occupy the Fe+3 (ferric) molecules of the A3 cytochrome, preventing the production of ATP. Treatment should be focused at maintaining ventilation/perfusion ratios and restarting cellular respiration.

Hydrogen sulfide (sewer gas) has a similar mechanism of toxicity. Presentation will be similar to cyanides though treatment is not the same.

Signs & Symptoms: Altered LOC, Confusion, Coma, Typical signs and symptoms of hypoxia with normal SpO2, Possible NCPE, Redness to the skin, Lack of cyanosis, Tachycardic dysrhythmias. Low dose exposure: CNS excitation, Anxiety, Muscle tremors, Headache and Twitching

General Response: Establish zones of control to protect responders & the public Protect responders with appropriate PPE Entry: Level A Decon: Level C Transport: Level D w/ splash protection Decon victims with high volumes of water Specialized deon: Soap & water Does victim present risk of secondary contamination? YES

Specific Treatments:

● Supportive therapy with rapid administration of specific antidote

Hydroxocobalamin 5 GM over 15 minutes using provided DripSet Cyanide Only Binds to cyanide molecules to 5GM in 200mL NS at 2 gtts/sec using provided drip set form a non-toxic product

Sodium Nitrite If within 30 minutes of exposure - Sulfide Only Induces methemoglobinemia to 300mg IV/IO over 5-7 minutes scavenge hydrogen sulfide from the mitochondria 10mL of 3% solution in 50mL NS at 3gtts/sec 47

Monitor with RAD57. If SpMet >30% contact medical control

Treat seizures according to SEIZURE PROTOCOL

Ondansetron 4-8mg IV/IO/IM/ODT Prevents vomiting & secondary contamination risk

● Hyperbaric oxygen potentiates the effects of known antidotes.

Rationale for Treatment: Therapy is directed at freeing the A3 cytochrome. For cyanide poisoning this is done by binding the cyanide molecule to another substrate and allowing for excretion. Enough binding agent must be given for the absorbed dose of cyanide. Hydrogen sulfide has a high affinity for ferric iron molecules like those found in methemoglobinemia. This free cytochrome oxydase to restart cellular respiration. Treatment should be supportive to give these processes time to happen.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148621/

NFA, Advanced Life Support to Hazardous Material Incidents 2016 http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750038.html