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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.<\/jats:p>","DOI":"10.1017\/s1049023x00015909","type":"journal-article","created":{"date-parts":[[2016,8,24]],"date-time":"2016-08-24T07:49:28Z","timestamp":1472024968000},"page":"s49-s55","source":"Crossref","is-referenced-by-count":50,"title":["Focus on Smoke Inhalation\u2014The Most Common Cause of Acute Cyanide Poisoning"],"prefix":"10.1017","volume":"21","author":[{"given":"Marc","family":"Eckstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Maniscalco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2012,6,28]]},"reference":[{"key":"S1049023X00015909_ref023","doi-asserted-by":"publisher","DOI":"10.1016\/S0379-0738(01)00464-9"},{"key":"S1049023X00015909_ref013","doi-asserted-by":"publisher","DOI":"10.3109\/15563659609020235"},{"key":"S1049023X00015909_ref011","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199112193252502"},{"key":"S1049023X00015909_ref005","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/j.1742-1241.1983.tb07194.x","article-title":"A scare of cyanide poisoning","volume":"37","author":"Mouzas","year":"1983","journal-title":"Br J Clin Pract"},{"key":"S1049023X00015909_ref004","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1056\/NEJMc040696","article-title":"Case 6-2004: Severe burns from a nightclub fire","volume":"350","author":"Borron","year":"2004","journal-title":"N Engl J Med"},{"key":"S1049023X00015909_ref019","first-page":"457","article-title":"The Cincinnati DC-9 experience: Lessons in aircraft and airport safety","volume":"56","author":"Pane","year":"1985","journal-title":"Aviat Space Environ Med"},{"key":"S1049023X00015909_ref024","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198802000-00007"},{"key":"S1049023X00015909_ref002","doi-asserted-by":"publisher","DOI":"10.1080\/20024091064246"},{"key":"S1049023X00015909_ref022","doi-asserted-by":"publisher","DOI":"10.1520\/JFS12812J"},{"key":"S1049023X00015909_ref028","doi-asserted-by":"publisher","DOI":"10.1016\/0272-0590(87)90046-7"},{"key":"S1049023X00015909_ref020","doi-asserted-by":"publisher","DOI":"10.1520\/JFS11187J"},{"key":"S1049023X00015909_ref009","first-page":"193","article-title":"Antidotal treatment of cyanide poisoning","volume":"66","author":"M\u00e9garbane","year":"2003","journal-title":"J Chin Med Assoc"},{"key":"S1049023X00015909_ref018","first-page":"167","article-title":"The occurrence of cyanide in the blood of fire victims","volume":"11","author":"Wetherell","year":"1966","journal-title":"J Forensic Sci"},{"key":"S1049023X00015909_ref029","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1984.10545871"},{"key":"S1049023X00015909_ref026","doi-asserted-by":"publisher","DOI":"10.1016\/0300-483X(86)90073-9"},{"key":"S1049023X00015909_ref033","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":"S1049023X00015909_ref027","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1979.10667431"},{"key":"S1049023X00015909_ref031","unstructured":"31 Baskin SI , Brewer TG : Cyanide Poisoning. 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