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Jan Trojanowski PGY-5 Emerg UWO

Jan Trojanowski PGY-5 Emerg UWO. Goals and Objectives. Case presentation Management principles New( ish ) developments Expert recommendations. Case. Plastics factory fire 22 y.o . female worker No burns, no injuries Soot in mouth GCS 3 ??? Seizure. Case cont’d.

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Jan Trojanowski PGY-5 Emerg UWO

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  1. Jan Trojanowski PGY-5 Emerg UWO

  2. Goals and Objectives • Case presentation • Management principles • New(ish) developments • Expert recommendations

  3. Case • Plastics factory fire • 22 y.o. female worker • No burns, no injuries • Soot in mouth • GCS 3 • ??? Seizure

  4. Case cont’d • IV, intubated by EMS • 96/50, 36.7oC, HR = 45, RR = 26, 96% • Skin = cherry red • Nurse says… Smells like burnt almonds in here!!

  5. Case cont’d Doctor, do something!! • Investigations • pH 6.95 • pO2 70 • pCO2 60 • HCO3 4 • AG 26 • Lactate >10 • CO 29%

  6. Add it all up… • Plastics fire • COMA • ?Seizure • Lactate >10 • Smells like almonds = CYANIDE

  7. Cyanide cyanide

  8. Cyanide • Cyanide Antidote Kit (aka Lilly Kit) • Components? • Amyl nitrite pearls • Sodium nitrite • Sodium thiosulfate • Downsides?

  9. Another silver bullet? • Hydroxocobalamin • Adult: 2.5g in 100cc NS x2 Cyanide hydroxocobolamin Cyanocobalamin

  10. Hydroxocobalamin • Interferes with colorimetric tests (ie. HGB, Cr, glu, albumin, INR/PTT, CK, etc.) • Hypertension

  11. Hydroxocobalamin notes • Fire brigades in Paris • Prehospital/EMS • Lilly kit (no longer made) • Cyanide kit • Special access • $400 • Hydroxocobalamin • Special access • $800

  12. Ann Emerg Med. 2009 Sep;54(3):386-394

  13. Cyanide OPCC stats • 2009 (to date) • 52 519 calls • 8 presumed cyanide exposures (2 deaths) • No clinical ability to measure CN levels

  14. ????

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