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Focus on Smoke Inhalation—The Most Common Cause of Acute Cyanide Poisoning

Published online by Cambridge University Press:  28 June 2012

Marc Eckstein  and
Paul M. Maniscalco
Marc Eckstein*
Affiliation:
Keck School of Medicine, University of Southern California and Los Angeles Fire Department, Los Angeles, California, USA
Paul M. Maniscalco
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC, USA
*
Correspondence: E-mail: [email protected]
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Abstract

The contribution of smoke inhalation to cyanide-attributed morbidity and mortality arguably surpasses all other sources of acute cyanide poisoning. Research establishes that cyanide exposure is: (1) to be expected in those exposed to smoke in closed-space fires; (2) cyanide poisoning is an important cause of incapacitation and death in smoke-inhalation victims; and (3) that cyanide can act independently of, and perhaps synergistically with, carbon monoxide to cause morbidity and mortality. Effective prehospital management of smoke inhalation-associated cyanide poisoning is inhibited by: (1) a lack of awareness of fire smoke as an important cause of cyanide toxicity; (2) the absence of a rapidly returnable diagnostic test to facilitate its recognition; and (3) in the United States, the current unavailability of a cyanide antidote that can be used empirically with confidence outside of hospitals. Addressing the challenges of the prehospital management of smoke inhalation-associated cyanide poisoning entails: (1) enhancing the awareness of the problem among prehospital responders; (2) improving the ability to recognize cyanide poisoning on the basis of signs and symptoms; and (3) expanding the treatment options that are useful in the prehospital setting.

Keywords

Cyanide Antidote Kitcyanide poisoningprehospital recognitionsmoke inhalation
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 21 , supplement S2: Cyanide Intoxication: Pathophysiology, Diagnosis, and Treatment: Invited Papers , April 2006 , pp. s49 - s55
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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References

1Borron, SW, Gaud, FJ: Toxicity, cyanide. February 2003. Available at http://www.emedicine.com/emerg/topic118.htm. Accessed 13 January 2004.Google Scholar
2Alarie, Y: Toxicity of fire smoke. Crit Rev Toxicol 2002;32:259–289.CrossRefGoogle ScholarPubMed
3Sheridan, RL, Schulz, JT, Ryan, CM et al. , : Case 6—2004: A 35-year-old woman with extensive, deep burns from a nightclub fire. N Engl J Med 2004;350:810–821.CrossRefGoogle ScholarPubMed
4Borron, SW, Mégarbane, B, Baud, FJ: Case 6-2004: Severe burns from a nightclub fire. N Engl J Med 2004;350:2314. (Letter)Google ScholarPubMed
5Mouzas, GL, Smith, RL, Syed, AL: A scare of cyanide poisoning. Br J Clin Pract 1983;37:245–248.CrossRefGoogle ScholarPubMed
6Lowry, WT, Juarez, L, Petty, CS et al. , : Studies of toxic gas production during actual structural fires in the Dallas area. J Forensic Sci 1985;30:59–72.CrossRefGoogle ScholarPubMed
7Lee-Chiong, TL: Smoke inhalation injury. Postgrad Med 1999;105:55–62.CrossRefGoogle ScholarPubMed
8Kulig, K: Cyanide antidotes and fire toxicology. N Engl J Med 1991;325: 1801–1802.CrossRefGoogle ScholarPubMed
9Mégarbane, B, Delahaye, A, Goldgran-Tolédano, D et al. , : Antidotal treatment of cyanide poisoning. J Chin Med Assoc 2003;66:193–203.Google ScholarPubMed
10Sauer, SW, Keim, ME: Hydroxocobalamin: improved public health readiness for cyanide disasters. Ann Emerg Med 2001;37:635–641.CrossRefGoogle ScholarPubMed
11Baud, F, Barriot, P, Toffis, V et al. , : Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 1991;325:1761–1766.CrossRefGoogle ScholarPubMed
12Moriya, F, Hashimoto, Y: Potential for error when assessing blood cyanide concentrations in fire victims. J Forensic Sci 2001;46:1421–1425.CrossRefGoogle ScholarPubMed
13Shusterman, D, Alexeeff, G, Hargis, C. et al. , : Predictors of carbon monoxide and hydrogen cyanide exposure in smoke inhalation patients. J Toxicol Clin Toxicol 1996;34:61–71.CrossRefGoogle ScholarPubMed
14Jones, J, McMullen, MJ, Dougherty, J: Toxic smoke inhalation: Cyanide poisoning in fire victims. Am J Emerg Med 1987;5:318–321.CrossRefGoogle ScholarPubMed
15Barillo, DJ, Goode, R, Esch, V: Cyanide poisoning in victims of fire: Analysis of 364 cases and review of the literature. J Burn Care Rehabil 1994;15:46–57.CrossRefGoogle ScholarPubMed
16Symington, IS, Anderson, RA, Thomson, I et al. , : Cyanide exposure in fires. Lancet 1978;2:91–92.CrossRefGoogle ScholarPubMed
17Anderson, RA, Harland, WA: Fire deaths in the Glasgow area: III. The role of hydrogen cyanide. Med Sci Law 1982;22:35–40.CrossRefGoogle ScholarPubMed
18Wetherell, HR: The occurrence of cyanide in the blood of fire victims. J Forensic Sci 1966;11:167–173.Google ScholarPubMed
19Pane, GA, Mohler, SR, Hamilton, GC: The Cincinnati DC-9 experience: Lessons in aircraft and airport safety. Aviat Space Environ Med 1985;56:457–461.Google ScholarPubMed
20Salomone, J III, Sohn, AP, Ritzlin, R et al. , : Correlations of injury, toxicology, and cause of death to Galaxy Flight 203 crash site. J Forensic Sci 1987;32:1403–1415.CrossRefGoogle ScholarPubMed
21Gill, JR, Goldfeder, LB, Stajic, M: The Happy Land homicides: 87 deaths due to smoke inhalation. J Forensic Sci 2003;48:161–163.CrossRefGoogle ScholarPubMed
22Levin, BC, Rechani, PR, Gurman, JL et al. , : Analysis of carboxyhemoglobin and cyanide in blood from victims of the Dupont Plaza hotel fire in Puerto Rico. J Forensic Sci 1990;35:151–168.CrossRefGoogle ScholarPubMed
23Ferrari, LA, Arado, MG, Giannuzzi, L et al. , : Hydrogen cyanide and carbon monoxide in blood of convicted dead in a polyurethane combustion: a proposition for the data analysis. Forensic Sci Int 2001;121:140–143.CrossRefGoogle Scholar
24Silverman, SH, Purdue, GF, Hunt, JL et al. , : Cyanide toxicity in burned patients. J Trauma 1988;28:171–176.CrossRefGoogle ScholarPubMed
25Mayes, RW: The toxicological examination of the victims of the British Air Tours Boeing 737 accident at Manchester in 1985. J Forensic Sci 1991;36:179–184.CrossRefGoogle ScholarPubMed
26Norris, JC, Moore, SJ, Hume, AS: Synergistic lethality induced by the combination of carbon monoxide and cyanide. Toxicology 1986;40:121–129.CrossRefGoogle ScholarPubMed
27Pitt, BR, Radford, EP, Gurtner, GH et al. , : Interaction of carbon monoxide and cyanide on cerebral circulation and metabolism. Arch Environ Health 1979;34:345–349.CrossRefGoogle Scholar
28Levin, BC, Paabo, M, Gurman, JL et al. , : Effects of exposure to single or multiple combinations of the predominant toxic gases and low oxygen atmospheres produced in fires. Fundam Appl Toxicol 1987;9:236–250.CrossRefGoogle ScholarPubMed
29Purser, DA, Grimshaw, P, Berrill, KR: Intoxication by cyanide in fires: A study in monkeys using polyacrylonitrile. Arch Environ Health 1984;39:394–400.CrossRefGoogle ScholarPubMed
30Purser, D: Behavioural impairment in smoke environments. Toxicology 1996;115:25–40.CrossRefGoogle ScholarPubMed
31Baskin, SI, Brewer, TG: Cyanide Poisoning. Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare. The Virtual Naval Hospital. Available at http://www.vnh.org/MedAspChemBioWar/chapters/chap-ter_10.hrm. Accessed February 22, 2004.Google Scholar
32Becker, CE: The role of cyanide in fires. Vet Hum Toxicol 1985;27:487–490.Google ScholarPubMed
33Hall, AH, Kulig, KW, Rumack, BH: Suspected cyanide poisoning in smoke inhalation: Complications of sodium nitrite therapy. Journal de Toxicologie Clinique et Expérimentale 1989;9:3–9.Google ScholarPubMed
34Moore, SJ. Norris, JC, Walsh, DA et al. , : Antidotal use of methemoglobin-forming cyanide antagonists in concurrent carbon monoxide/cyanide intoxication. J Pharmacol Exp Ther 1987;242:70–73.Google ScholarPubMed
35Hall, AH, Walsh, D, Maniscalco, P: Hydroxocobalamin as a cyanide antidote in prehospital first responder care. JEMS 2004;29(suppl): Abstract.Google Scholar
36Friedberg, KD, Shukla, UR: The efficiency of aquocobalamine as an antidote in cyanide poisoning when given alone or combined with sodium thiosulfate. Arch Toxicol 1975;33:103–113.CrossRefGoogle ScholarPubMed
37Hall, AH, Rumack, BH: Hydroxycobalamin/sodium thiosulfate as a cyanide antidote. J Emerg Med 1987;5:115–121..CrossRefGoogle ScholarPubMed