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Smoke inhalation cyanide risk — DipIMC MCQ

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HardEnvironmental MedicineSmoke inhalation cyanide riskDipIMC

A warehouse fire survivor is confused, hypotensive and has soot in the mouth. Pulse oximetry is normal but lactate from a critical care team is markedly raised. What is the most appropriate management?

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Correct answer: A — Treat smoke inhalation aggressively and consider cyanide antidote within specialist protocol

Treat smoke inhalation aggressively and consider cyanide antidote within specialist protocol is the best answer because severe smoke inhalation with shock and high lactate suggests possible cyanide toxicity. Provide reassurance and reassess after transport is less appropriate because reassurance is inadequate for an evolving major trauma problem; Defer treatment until a senior hospital doctor reviews the patient is less appropriate because pre-hospital clinicians must treat immediate threats within scope. Use oral analgesia as the main treatment and Give unrestricted crystalloid to normalise blood pressure are also suboptimal because they move attention away from the key pre-hospital priority.. The key DipIMC principle is to treat immediate reversible threats, communicate clearly and move the patient toward the right definitive care.

Reference: JRCALC Guidelines; TOXBASE/NPIS guidance; ATACC Manual