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Cyanide toxicity from smoke inhalation — ABEM Board MCQ

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HardPulmonary emergenciesCyanide toxicity from smoke inhalationABEM Board

A 50-year-old man is pulled from an enclosed-space fire and arrives comatose. Triage acuity is ESI 1; BP 78/46 mm Hg, HR 136/min, SpO2 100% on high-flow oxygen. He has soot in the airway and lactate 12 mmol/L. Carboxyhemoglobin is elevated but not enough to explain shock. Which of the following is the most important immediate intervention?

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Correct answer: C — Administer hydroxocobalamin

Severe lactic acidosis and shock after enclosed-space smoke inhalation suggest cyanide toxicity; hydroxocobalamin is first-line treatment.

Reference: CDC cyanide emergency guidance; burn inhalation injury guidance