Eckstein Marc, Maniscalco Paul M
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Prehosp Disaster Med. 2006 Mar-Apr;21(2):s49-55. doi: 10.1017/s1049023x00015909.
The contribution of smoke inhalation to cyanide-attributed morbidity and mortality arguably surpasses all other sources of acute cyanide poisoning. Research establishes that cyanide exposure is: (1) to be expected in those exposed to smoke in closed-space fires; (2) cyanide poisoning is an important cause of incapacitation and death in smoke-inhalation victims; and (3) that cyanide can act independently of, and perhaps synergistically with, carbon monoxide to cause morbidity and mortality. Effective prehospital management of smoke inhalation-associated cyanide poisoning is inhibited by: (1) a lack of awareness of fire smoke as an important cause of cyanide toxicity; (2) the absence of a rapidly returnable diagnostic test to facilitate its recognition; and (3) in the United States, the current unavailability of a cyanide antidote that can be used empirically with confidence outside of hospitals. Addressing the challenges of the prehospital management of smoke inhalation-associated cyanide poisoning entails: (1) enhancing the awareness of the problem among prehospital responders; (2) improving the ability to recognize cyanide poisoning on the basis of signs and symptoms; and (3) expanding the treatment options that are useful in the prehospital setting.
吸入烟雾对氰化物所致发病和死亡的影响，可以说超过了所有其他急性氰化物中毒来源。研究表明，氰化物暴露情况如下：（1）在封闭空间火灾中接触烟雾的人群中会出现氰化物暴露；（2）氰化物中毒是烟雾吸入受害者丧失行动能力和死亡的重要原因；（3）氰化物可独立作用，或许还能与一氧化碳协同作用，导致发病和死亡。院前对烟雾吸入相关氰化物中毒的有效管理受到以下因素的制约：（1）缺乏对火灾烟雾作为氰化物毒性重要原因的认识；（2）缺乏可快速得出结果的诊断测试以促进对其的识别；（3）在美国，目前无法获得可在院外放心经验性使用的氰化物解毒剂。应对院前烟雾吸入相关氰化物中毒管理的挑战需要：（1）提高院前急救人员对该问题的认识；（2）提高根据体征和症状识别氰化物中毒的能力；（3）扩大在院前环境中有用的治疗选择。
