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Smoke inhalation cyanide — DipIMC MCQ

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HardEnvironmental MedicineSmoke inhalation cyanideDipIMC

A patient rescued from an enclosed-space fire has soot around the airway, coma, cardiovascular collapse and severe lactic acidosis. Alongside airway, oxygenation and circulatory support, which antidote should be considered for suspected cyanide poisoning?

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Correct answer: B — Give hydroxocobalamin by IV infusion

The best answer is “Give hydroxocobalamin by IV infusion”. Enclosed-space smoke exposure with coma, shock and marked lactic acidosis is compatible with cyanide toxicity. The UK product authorisation supports hydroxocobalamin for known or suspected cyanide poisoning, administered with full resuscitation and specialist toxicology advice. It should not delay airway management or high-concentration oxygen. The alternative antidotes treat different toxic mechanisms and do not substitute for cyanide-directed treatment.

Reference: Cyanokit Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/4786/smpc