The emergency treatment of smoke inhalation offers perhaps the single best reason for the healthcare community to demand 24/7 access to hyperbaric chambers across the US. Cyanide, carbon monoxide, inhaled particulates, and thermal injuries together require speedy action to save the lives of firefighters and other fire victims. The clinical evidence for HBOT may not be as strong for nonfire cyanide poisoning as for nonfire carbon monoxide poisoning, but the benefits of oxygen are well established. As [Medscape] puts it: “Oxygen and sodium thiosulfate are the most widely accepted cyanide antidotes…. The mechanism of action of oxygen as a cyanide antidote is unclear, but it potentiates the effect of other antidotes. When used in the setting of smoke inhalation, it is also therapeutic for CO poisoning. Thus, high concentrations of oxygen should be promptly delivered.” Ongoing surveillance projects and prospective trials may bolster the clinical case for HBOT in the routine treatment of smoke inhalation.
Cyanide is a rapidly acting and deadly chemical. Smelling of bitter almonds or entirely odorless, cyanide may take the form of a colorless gas, a liquid, or a crystal powder. Many plants, foods, and microbes produce harmless cyanides, and for decades cyanides have been used safely in manufacturing. Cigarette smoke contains traces of cyanide. Cyanide has also been used as an agent of chemical warfare and domestic terrorism. Our selection for Further Reading provides an insightful account of the still-unsolved 1982 Chicago Tylenol murders.