Cyanide Poisoning

A 28-year-old woman is admitted to the ICU with suspected cyanide poisoning from ingestion of cassava root (containing cyanogenic glycosides). She is drowsy, has a respiratory rate of 32/min, and blood pressure is 88/54 mmHg. Arterial blood gas shows severe metabolic acidosis (pH 7.15, HCO₃⁻ 10 mEq/L) and lactate 10.5 mmol/L. She has already received sodium nitrite 10 mL IV and sodium thiosulfate 50 mL IV 15 minutes ago but remains critically ill. What is the most appropriate next step?

A 28-year-old woman is admitted with suspected cyanide poisoning following accidental inhalation in an industrial accident. She is unconscious with a respiratory rate of 8/min and blood pressure 80/50 mmHg. While awaiting confirmatory serum cyanide levels, which investigation would best guide immediate assessment of tissue hypoxia and guide treatment decisions?

A 32-year-old industrial worker is brought to the emergency department after suspected exposure to cyanide gas at a chemical plant. His arterial blood gas shows a normal PaO₂ (95 mmHg) and normal oxygen saturation (98%), yet he is unconscious with severe metabolic acidosis. Which single feature best distinguishes acute cyanide poisoning from carbon monoxide poisoning in this clinical scenario?

A 32-year-old woman is admitted 20 minutes after intentional ingestion of potassium cyanide (KCN) in a suicide attempt. She is unconscious, with fixed dilated pupils, generalized seizures, and profound bradycardia (HR 38/min). Skin is cyanotic despite supplemental oxygen at 15 L/min via non-rebreather mask. Blood pressure is 78/52 mmHg. Venous blood gas shows SvO₂ (mixed venous oxygen saturation) of 88% (normal 70–75%). Which antidote should be administered first as part of the immediate management?

A 32-year-old man is brought to the emergency department 15 minutes after suspected cyanide ingestion. He is unconscious, with fixed dilated pupils, rapid shallow breathing, and a strong smell of bitter almonds on his breath. Regarding the clinical features and management of cyanide poisoning, all of the following are correct EXCEPT: