Which medication should be given to a smoke inhalation patient in cardiac arrest, hypotension, or profound AMS?

Which medication should be given to a smoke inhalation patient in cardiac arrest, hypotension, or profound AMS?

• A. Hydroxocobalamin 5 g IV over 15 mins
• B. Naloxone 2 mg IV
• C. Sodium nitroprusside 0.5 mg IV
• D. Epinephrine 1 mg IV

Answer: (A)

Smoke inhalation can deliver cyanide, which blocks cellular respiration and can cause rapid deterioration with cardiac arrest, hypotension, or profound AMS. Hydroxocobalamin directly counteracts cyanide by binding it to form cyanocobalamin, which is then excreted in the urine. This antidote rapidly restores cellular oxygen usage and improves perfusion, making it the treatment of choice in these scenarios. The standard prehospital dose is 5 g IV over about 15 minutes. Naloxone would address opioid toxicity, not cyanide poisoning; sodium nitroprusside would release more cyanide and worsen the problem; epinephrine helps with cardiac arrest physiology but does not neutralize the toxin itself.

Smoke inhalation can deliver cyanide, which blocks cellular respiration and can cause rapid deterioration with cardiac arrest, hypotension, or profound AMS. Hydroxocobalamin directly counteracts cyanide by binding it to form cyanocobalamin, which is then excreted in the urine. This antidote rapidly restores cellular oxygen usage and improves perfusion, making it the treatment of choice in these scenarios. The standard prehospital dose is 5 g IV over about 15 minutes. Naloxone would address opioid toxicity, not cyanide poisoning; sodium nitroprusside would release more cyanide and worsen the problem; epinephrine helps with cardiac arrest physiology but does not neutralize the toxin itself.