1. In-Service Los Alamos Fire Department

2.  Cyanide makes the cells of an organism unable to use oxygen. Inhalation of high concentrations of cyanide causes a coma with seizures, apnea and cardiac arrest, with death following in a matter of minutes. At lower doses, loss of consciousness may be preceded by general weakness, giddiness, headaches, vertigo, confusion, and perceived difficulty in breathing. At the first stages of unconsciousness, breathing is often sufficient or even rapid, although the state of the victim progresses towards a deep coma, sometimes accompanied by pulmonary edema, and finally cardiac arrest. Skin color goes pink from cyanide- hemoglobin complexescomaseizuresapnea cardiac arrest headachesvertigopulmonary edema

3.  Hydroxocobalamin is a form of vitamin B-12  Hydroxocobalamin works by helping cells in the body convert cyanide to a form that can be removed from the body through urination

4.  Severe Side Effects: Increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure); fast or uneven heart rate; bright red blood in your stools; or swelling in your hands or feet.

5. FCD 500.8 page 3  Of prime importance is the protection of the rescuer. No attempt at rescue should be performed until an appropriate hazard assessment of the exposure site is made, and appropriate PPE and staff is in place. Removal of victims as rapidly as possible to a fresh air environment is crucial, but not at the expense of provider safety.

6. FCD 500.8 page 3 1. All EMS Providers A. Gross decontamination per FCD 400.24, 400.31 B. Establish Primary management 2. ILS Providers Rapid IV access using large bore cannula and 10 gtts tubing with NS to maintain perfusion. If possible start a second large bore IV for medication infusion.

7. 3. ALS Providers A. Monitor EKG B. Rapid administration of Cyanokit contents C. Hydroxocobalamin: 1. Adult dose: 5 Gm over 15 minutes depending on severity of poisoning and clinical response. A second 5 Gm dose may be administered over 15 minutes for a total of 10 Gm if needed. 2. Pediatric dose: 70 mg/kg to 2.5 Gm total over 20 minutes x one dose only.

8. QUESTIONS???