Decontamination and Treatment

Decontamination: Initial disrobing, then soap and water showering.

Treatment: O2, cyanide kit = amyl nitrite, sodium thiosulfate, support.

Miscellaneous treatment: Cyanocobalamin (B12); methylene blue; correct metabolic acidosis; support urine output.

Treatment mechanism: (1) Oxidize ferrous oxyhemoglobin (oxyHb+2) to ferric methemoglobin (metHb+3) with nitrates to bind free CN- and form cyanomethemoglobin, (2) competitively pull CN- out of the ferrous oxyhemoglobin moiety with thiosulfate to form urine-excreta-ble thiocyanate, (3) reverse methemoglobinemia with methylene blue.

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