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Posted by Robert Marschall, The fire fighter that was exposed to the smoke containing the hydrogen cyanide gas had a very unique presentation of signs and symptoms. At the time of exposure he was not wearing a SCBA as the structure was outside and all the buildings wall were on the ground. He was fighting an open air ground fire. The contents were numerous and no one knewn what was in the containers as this was an outside shed. Not wearing or using supplied air allows for exposure to toxic fuses that were produced as a byproduct of incomplete combustion. Most notoriously is carbon monoxide and cyanide. This caused one of the Fire Fighters on scene to be overcome by cyanide gas. He was treated on scene by the rescue crew and transported to the hospital. The signs and symptoms that were displayed included altered level of consciousness with brief periods of unconsciousness. Simple stimulation seemed to arouse the patient. While having these brief periods of unconsciousness the heart rate and respiratory rate would drop. This also included periods of hypotension. The patient complained of chest pressure and numbness to the left arm. The crew initiated ALS supportive care with oxygen administration, 12-lead and ECG monitoring, and established an IV. When the patient had a period of apnea they attempted to place a NPA that aroused the patient enough to support adequate breathing. Pulse oximetry on oxygen was 98 – 100%. ECG rhythm analysis was Sinus rhythm to Sinus Bradycardia (HR<60) and no ectopy. 12-lead ECG showed no ischemic changes. Care was then turned over to the ER physician at the hospital with no improvement to signs and symptoms. This exposure demonstrates some of the classic signs and symptoms to cyanide. Hydrogen cyanide is a colorless gas with a faint bitter almond smell. It is classified as a systemic asphyxiant. That means it blocks the bodies ability to get oxygen into the cells. It can even cause a heart attack which may throw healthcare providers off the track of treating a cyanide exposure. Low levels of cyanide over a 30 minute time period can cause significant signs and symptoms. Here is a list of some possible signs and symptoms when exposed to cyanide headache, drowsiness, Vertigo / dizziness, weak and rapid pulse, deep and rapid breathing, a bright-red color in the face, Metallic taste, nausea and vomiting, convulsions, dilated pupils, clammy skin, a weaker and more rapid pulse, slower and shallower breathing, Heart slows body temperature falls, and anxiety develops. A patient may have any portion of combination of these signs and symptoms. If left untreated or unrecognized cyanide exposure can lead to death. Most of the time with mild exposure we have a tendency to pass theses off as something else. Over time these mild symptoms go away and resolve. Some of these same symptoms are associated with carbon monoxide exposure. Carbon monoxide exposure improves with just oxygen. Cyanide exposure signs and symptoms do not improve with oxygen and may get worse because no treatment has begun. |
