Cyanide Toxicity

Cyanide poisoning is a cellular oxygen-use emergency. The patient may have oxygen-rich arterial blood and a reassuring pulse oximeter while the brain and myocardium are already failing because their mitochondria cannot use that oxygen. In a smoke-inhalation victim, the combination of altered mental status, severe lactic acidosis, and a normal or near-normal SpO2 should move cyanide toxicity high on the priority list. The nurse supports oxygenation and circulation immediately, obtains the most useful bedside data, and prepares hydroxocobalamin without waiting for a cyanide level.