methylene blue antidote cyanide poisoning

The patient's EKG can be seen in Figure A. She also appears flushed, her pupils are dilated, and she has scattered urticaria. Upon physical exam, the patient is agitated and grabbing at the air. Her temperature is 102☏ (38.9☌), blood pressure is 122/82 mmHg, pulse is 132/min, and respirations are 18/min with an oxygen saturation of 98% O2 on room air. Her medications include amphetamine, desipramine, intranasal ipratropium, and diphenhydramine as needed. The patient’s past medical history is otherwise significant for ADHD, depression, and seasonal allergies. The boyfriend also reports that the patient recently received a negative evaluation at work and that she has been stressed. He reports that when he tried to talk to her, she was 'out of it' and kept asking for water.

When the patient’s boyfriend arrived home, he found the patient agitated and disoriented. He reports that the patient had told him that she was staying home from work because of her allergies, which had been bothering her all week. In addition to sending the patient for cardiac catherization, what is the most appropriate next step in management?Ī 32-year-old female is brought to the emergency department by her boyfriend for confusion. However, a new lesion has also formed, as shown in Figure B. On physical exam, the right leg is again swollen and tender to palpation. An electrocardiogram is performed and is shown in Figure A.Ī CBC was performed with the following findings: Seven days later the patient arrives back to the ED complaining of crushing substernal chest pain. The appropriate anti-coagulation therapy is started. Other physical exam findings are negative.Ī complete blood count (CBC) was performed with the following findings: On physical exam, his right leg appears moderately erythematous, swollen, and is tender to palpation. He denies chest pain or shortness of breath.

On arrival, his temperature is 99☏ (37.2☌), blood pressure is 135/82 mmHg, pulse is 88/minute, and oxygen saturation is 99% O2. His current medications include aspirin, lisinopril, metformin, and atorvastatin. His past medical history is significant for hypertension and diabetes.

The patient reports he recently underwent a total hip replacement. A 65-year-old man arrives to the emergency department (ED) complaining of pain and swelling in his right leg.

Methylene blue antidote cyanide poisoning