Both the head CT and the chest x-ray returned within normal limits as well.
All other labs were within normal limits. The patient’s lactate level was 8.3 mmol/L. The ABG revealed a pH of 7.26, a PO 2 of 594.2 mmHg, an HCO 3 of 16.4 mmol/L, and an oxygen saturation of 100% In addition, the blood appeared chocolate brown and a methemoglobin level of 75.4% was revealed along with a carboxyhemoglobin level of zero. Labs drawn included an arterial blood gas (ABG), complete blood count, complete metabolic panel, lactate, blood alcohol, acetaminophen, aspirin, and ethylene glycol level were drawn. The patient’s physical exam was normal with the exception of 1 mm pupils that were minimally reactive, clubbing of the hands and toes, and severe cyanosis. The patient’s pulse oximetry reading was not detectable despite the administration of 100% FiO2 via ET tube. Vital signs upon arrival included a temperature of 96.5 F, a blood pressure of 101/52, a pulse rate of 125 beats per minute, and a respiratory rate of 18 breaths per minute. During transportation to the emergency room, the patient became very combative and sedation with a midazolam bolus and infusion was initiated to maintain the patient’s Endotracheal (ET) tube. In addition, a 0.4 mg bolus of naloxone was administered intravenously with no response. A call was placed to 911 and upon arrival of emergency medical services, the patient was unresponsive, appeared blue and was intubated with out medications due to his severe cyanosis. " Facts about Cyanide." Centers for Disease Control and Prevention, 2018.A 45 year old male with a history of hypertension, polysubstance abuse, and anxiety was found unconscious for an unknown period of time in a parking lot.
" Cyanides in the environment-analysis-problems and challenges." Environmental Science and Pollution Research, vol. Jaszczak Ewa, Zaneta Polkowska, Sylwia Narkowicz, and Jacek Namiesnik. " Sodium Cyanide: Systematic Agent." The National Institute for Occupational Safety and Health (NIOSH), 2011. " Cyanide Toxicity." NCBI StatPearls, National Center for Biotechnology Information, 2019. " Challenges in the diagnosis of acute cyanide poisoning." Clinical Toxicology (Phila), vol. " Acute cyanide poisoning among jewelry and textile industry workers." American Journal of Emergency Medicine, vol. " Metabolism of cyanogenic glycosides: A review." Food and Chemical Toxicology, vol. Bortey-Sam, Nesta, et al. " Diagnosis of cyanide poisoning using an automated, field-portable sensor for rapid analysis of blood cyanide concentrations." Analytica Chimica Acta, vol.
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