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Cyanide toxicity from smoke inhalation — RCPSC EM MCQ

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HardToxicologyCyanide toxicity from smoke inhalationRCPSC EM

A 40-year-old is rescued from an enclosed-space industrial fire. He is confused, hypotensive, and has soot in the nares. Lactate is 12 mmol/L despite adequate oxygenation and COHb is 9%. What is the most appropriate initial management?

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Correct answer: E — Give hydroxocobalamin and manage the airway

Give hydroxocobalamin and manage the airway is correct: the clues indicate Cyanide toxicity from smoke inhalation and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Goldfrank's Toxicologic Emergencies; Canadian poison centre practice