A patient is brought to the ED from a fire occurring inside an enclosed building where polyurethane foams were present. He is conscious, but presents with increasing mental dullness, headache, and severe dyspnea. Oxygen saturation by pulse oximetry is 92% and capillary lactic acid is 8 mEq/l. What specific treatment do you consider most appropriate?
The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes). Knowing this, and that we are dealing with cyanide poisoning, it is easier to answer the question. Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin (this was asked similarly last year). Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning. What is stated in option 4 about fluid therapy is not indicated; in case of associated shock, volume would be administered, but in any case not at that rate, but in rapid boluses.
Administration of oxygen by means of a 50% Venturi type mask.
Administration of intravenous hydroxycobalamin.
Ventilation with hyperbaric chamber.
Fluid therapy with infusion of physiological saline solution at 21 ml/h.
Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1),
Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin
Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning.
What is stated in option 4 about fluid therapy is not indicated; in case of associated shock, volume would be administered, but in any case not at that rate, but in rapid boluses.