Decontamination

Following ingestion, cyanide is rapidly absorbed and CNS toxicity occurs quickly, so early gastrointestinal decontamination with activated charcoal is important. However, decontamination should not delay resuscitation or administration of antidotes.

Most patients with cyanide poisoning will be unconscious and require intubation. Give activated charcoal to patients who present within 2 hours after the estimated ingestion time, after the airway has been secured. Once the patient is intubated, activated charcoal can be given via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.