When should a patient with suspected cyanide poisoning be urgently referred to secondary care or an emergency department?

A patient with suspected cyanide poisoning should be urgently referred to secondary care or an emergency department immediately if there is any clinical suspicion of cyanide exposure or poisoning. This is because cyanide poisoning is a life-threatening emergency requiring rapid assessment and treatment in a setting equipped for resuscitation and advanced supportive care.

Urgent referral is indicated if the patient shows signs of severe toxicity such as altered mental state, respiratory distress, cardiovascular instability, or any rapid deterioration in clinical condition. Immediate transfer by emergency services (e.g., 999 ambulance) is appropriate to ensure timely access to antidotes and critical care facilities.

In the absence of specific UK guideline excerpts on cyanide poisoning in the provided context, the general principle for suspected severe poisoning or toxic exposure is to refer urgently to hospital for emergency management. This aligns with the approach for other life-threatening conditions requiring rapid hospital-based intervention.