Carbon monoxide and cyanide are the main gases produced during combustion in fires: they are responsible for a syndrome of oxygen deprivation. It represents the first cause of death at the fire scene and after hospital admission.

Smoke inhalation causes systemic and mucosal toxicity due to the asphyxiant and irritant properties of toxic gases. Therapeutic abortion may be indicated in the presence of fetal demise following obstetric evaluation and stabilization of the mother. Administer hydroxocobalamin or sodium thiosulphate and sodium nitrite if the diagnosis is strongly suspected. Management of cyanide toxicity involves air way control, ventilation and 100% oxygen, crystalloids and vasopressor, as needed for hypertension, Sodium bicarbonate is titrated according to arterial blood gas (ABG) and serum bicarbonate level decontaminate the patient with removal of clothing /skin flushing and/or activated charcoal (1g/kg), as appropriate in alert patients or after endotracheal intubation in an unconscious patient through a nasogastric tube after gastric lavage. Clinical features include: initial bradycardia and hypertension, then transient tachypnea, cherry red skin, sooth in the mouth, normal or dilated pupils, diaphoresis, altered mental status, mydriasis, ataxia, generalized convulsions and coma. Cyanide toxicity occurs when cyanide attaches itself to ubiquitous metalloenzymes, rendering cytochrome oxidase inactive, thereby uncoupling mitochondrial oxidase phosphorylation and inhibiting cellular respiration, even in the presence of adequate oxygen stores, consequently affecting tissues (brain and heart) with the highest oxygen requirement. Historically, cyanide has been used as a chemical warfare agent, and it could potentially be an agent for a terrorist attack. Although, a rare form of poisoning, smoke inhalation, suicidal ingestion, industrial exposure, treatment with sodium nitroprusside, long term consumption of cyanide containing foods like apricot, poorly processed cassava, and apple seeds are possible sources of cyanide poisoning.

Cyanide toxicity occurs when a living organism is exposed to a compound that produces cyanide ion (CN-) when dissolved in water.

Lilly cyanide antidote kit