Friday, October 15, 2004

Supportive therapy

Possibly the most important elements of therapy are general supportive actions, which, by themselves, can effect the recovery of most casualties without further risk from specific antidotal therapy. There are probably the only indicated therapies for casualties of cyanide poisoning who arrive conscious at the emergency medical treatment situation.
For correcting of the anoxia : 100% OXYGEN therapy immediately; duration : 3 hours ; after improvement 50% oxygen for 3 hours and 30 % oxygen for 24 hours (endotracheal intubation if necessary) hyperbaric oxygen can be used when CNS does not improve with traditional treatment. The use of hyperbaric oxygen in cyanide intoxication is still controversial. Supplemental oxygen with or without assisted ventilation clearly augment the effect of specific antidotes in animal studies; however, despite encouraging reports, there is inconclusive evidence of further benefit from the use of hyperbaric oxygen3,4. Artificial respiration, mouth to mouth resuscitation should be avoided because has risk of self poisoning ; cyanide products are eliminated unchanged by the lung1,7,10.
Lactic acidosis resulting from anaerob metabolism should be treated by intravenous administration of sodium bicarbonat 1 milliequivalent /Kg; further administration will be based on arterial blood gas determinations. Seizures controlled by the administration of anticonvulsants such as diazepam. Because correction of deficiencies in tissue perfusion and oxygenation is the ultimate goal of supportive therapy and is also important for the success of specific antidotal therapy, it is critically important to maintain an effective cardiac rhythm; this can be accomplished with cardiopulmonary resuscitation, if necessary, in the early stages of treatment.


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