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The ability to meet the challenge of managing cyanide poisoning in the prehospital setting may be enhanced by the availability of the cyanide antidote hydroxocobalamin, currently under development for potential introduction in the United States. This paper discusses the causes, recognition, and management of acute cyanide poisoning in the prehospital setting with emphasis on the emerging profile of hydroxocobalamin, an antidote that may have a risk:benefit ratio suitable for empiric, out-of-hospital treatment of the range of causes of cyanide poisoning. If introduced in the US, hydroxocobalamin may enhance the role of the US prehospital responder in providing emergency care in a cyanide incident.<\/jats:p>","DOI":"10.1017\/s1049023x00015892","type":"journal-article","created":{"date-parts":[[2016,8,24]],"date-time":"2016-08-24T07:49:28Z","timestamp":1472024968000},"page":"s40-s48","source":"Crossref","is-referenced-by-count":23,"title":["Acute Cyanide Poisoning in Prehospital Care: New Challenges, New Tools for Intervention"],"prefix":"10.1017","volume":"21","author":[{"given":"Tee","family":"Guidotti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2012,6,28]]},"reference":[{"key":"S1049023X00015892_ref004","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000127771.06138.7D"},{"key":"S1049023X00015892_ref019","unstructured":"19Chemical Casualty Care Division, Aberdeen Proving Ground, MD. Cyanide AC, CK. United States Army Medical Research Institute of Chemical Defense: Medical Management of Chemical Casualties Handbook, 3rd edition. The Virtual Naval Hospital Project, 1997-2004. Available at http:\/\/www.vnh.org\/CHEMCASU\/03Cyanide.html. Accessed 13 January 2004."},{"key":"S1049023X00015892_ref018","first-page":"107","article-title":"US Department of Health and Human Services, Public Health Service: Cyanide toxicity","volume":"48","year":"1993","journal-title":"Am Fam Phys"},{"key":"S1049023X00015892_ref027","first-page":"121","article-title":"Study of the mechanisms involved in hydroxocobalamin interference with determination of some biochemical parameters","volume":"52","author":"Gourlain","year":"1994","journal-title":"Ann Biol Clin"},{"key":"S1049023X00015892_ref012","unstructured":"12 Borron SW , Baud FJ : Toxicity, cyanide. February 2003. Available at http:\/\/www.emedicine.com\/emerg\/topic118.htm. 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DHEW (NIOSH) Publication No. 77\u2013108. US Department of Health Education and Welfare: Washington DC. October 1976."},{"key":"S1049023X00015892_ref014","first-page":"193","article-title":"Antidotal treatment of cyanide poisoning","volume":"66","author":"M\u00e9garbane","year":"2003","journal-title":"J Chin Med Assoc"},{"key":"S1049023X00015892_ref028","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(94)70164-4"},{"key":"S1049023X00015892_ref022","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2005.02.008"},{"key":"S1049023X00015892_ref013","unstructured":"13National Safety Council: Hydrogen cyanide chemical backgrounder. Available at http:\/\/www.nsc.org\/library\/chemical\/Hydrocya.htm. Accessed 13 January 2006."},{"key":"S1049023X00015892_ref002","article-title":"Hydroxocobalamin as a cyanide antidote in prehospital first responder care","volume":"20","author":"Hall","year":"2004","journal-title":"JEMS"},{"key":"S1049023X00015892_ref007","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X00015909"},{"key":"S1049023X00015892_ref030","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.1997.tb02561.x"},{"key":"S1049023X00015892_ref021","first-page":"3","article-title":"Suspected cyanide poisoning in smoke inhalation: Complications of sodium nitrite therapy","volume":"9","author":"Hall","year":"1989","journal-title":"Journal de Toxicologie Clinique et Exp\u00e9rimentale"},{"key":"S1049023X00015892_ref026","first-page":"399","article-title":"Hydroxocobalamin is an effective antidote in severe acute cyanide poisoning in man","volume":"23","author":"Borron","year":"2004","journal-title":"Int J Toxicol"},{"key":"S1049023X00015892_ref017","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-6757(03)00088-3"},{"key":"S1049023X00015892_ref025","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.06.288"},{"key":"S1049023X00015892_ref024","doi-asserted-by":"publisher","DOI":"10.3109\/15563659609013809"},{"key":"S1049023X00015892_ref010","unstructured":"10 Baskin SI , Brewer TG : Cyanide Poisoning. In: Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare. The Virtual Naval Hospital. Available at http:\/\/www.vnh.org\/MedAspChemBioWar\/chapters\/chap-ter_10.hrm. Accessed 22 February 2004."},{"key":"S1049023X00015892_ref031","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.74.877.702"},{"key":"S1049023X00015892_ref009","volume-title":"Hydrogen Cyanide and Cyanides: Human Health Aspects. Concise International Chemical Assessment Document 61","year":"2004"},{"key":"S1049023X00015892_ref001","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.114315"},{"key":"S1049023X00015892_ref023","first-page":"18","article-title":"Hydroxocobalamin: treatment for smoke inhalation-associated cyanide poisoning. 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