CYANIDE IN FIRE SMOKE

Presumptive - Antidotal Treatment

Cyanide’s Destructive Qualities

Blocks aerobic metabolism and energy production: cellular hypoxia

– Cells immediately starve for oxygen and die– No amount of supplemental oxygen can

overcome the deficit in affected cells– Causes shift to anaerobic metabolism

Byproducts of anaerobic metabolism (e.g., lactic acid) accumulate

Death from central respiratory arrest

“Aftermath”

To address the complexities of HCN treatment, the Fire Smoke Coalition

produced “Aftermath” – a comprehensive video production about smoke inhalation, which

includes the presumptive diagnosis for consideration of cyanide

poisoning. This is not just about the firefighter population – it includes

civilians as well.

FDA Approved Cyanide Antidotes

CAK (Cyanide Antidote Kit) which contains Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate, is the most readily available antidote in most hospitals and the ONLY known to most physicians.

Which drug is contraindicated

In smoke inhalation patients?

FDA Approved CyanideAntidotes

- Nithiodote (a new cyanide antidote approved by the FDA in 2011) – but without new drugs (Sodium Nitrite and Sodium Thiosulfate) which will be marketed to hospitals for use as a new “cyanide antidote.”

Again, Nitrites.

FDA Approved CyanideAntidotes

-Cyanokit, which contains (2) 2.5mg vials of Hydroxocobalamin (Vitamin B12)- Not contraindicated in smoke inhalation victims and a preferred antidote by Coalition experts.

The Challenge: $$$ vs. Shelf Life (3yrs)

The Greatest Challenge with Cyanide Antidotes

Very few physicians and poison control centers are aware of the

difference between industrial cyanide poisoning and cyanide poisoning from

smoke inhalation AND, THEREFORE,

elect to use any “cyanide antidote” without understanding fire smoke

cyanide poisoning.

You are the Messenger

You, the firefighter / first responder, will be responsible for

educating your local medical community.

How?- Deliver a copy of “Aftermath”

- Share the “SMOKE publications

Does your Department need a life-saving cyanide

antidote? What good

is RIT without a Cyanokit?

Questions

www.Firesmoke.orgwww.FSCommunity.com