This information and these recommendations on the treatment of cyanide poisoning are aligned with the information in manufacturer’s safety data sheets.
Remove patient from exposure. Keep warm and at rest. Oxygen should be administered. If breathing has ceased apply artificial respiration using oxygen and a suitable mechanical device such as a bag and mask. Do not use mouth-to-mouth resuscitation. First aiders will require additional training in oxygen administration and the use of resuscitation techniques such as bag and mask.
Remove all contaminated clothing immediately. Wash the skin with plenty of water. Treat patient as for inhalation.
Immediately irrigate with water for at least ten minutes. Treat patient as for inhalation.
Do not give anything by mouth. Treat patient as for inhalation.
HSE advises that oxygen administration is the most useful initial treatment for cyanide poisoning. This means where cyanides are used at least one person should be trained to administer oxygen.
If breathing has stopped artificial respiration is essential. In the past, safety data sheets have advised that mouth-to-mouth resuscitation should not be used, because of the possible risk of secondary poisoning to the first aider. Manual techniques of artificial respiration are extremely inefficient so an alternative mechanical resuscitation device, through which oxygen can be given, is needed. The simplest solution is a bag and mask device connected to an oxygen supply. Other types of equipment could be used but in all cases the employer will have a responsibility to ensure that the first aider is trained to use the device.
HSE recommends that employers discuss the arrangements for the medical treatment of cyanide poisoning with their local hospital (Accident and Emergency Department) or other provider of medical care.
Historically three antidotes for cyanide poisoning were recommended for use in the UK. However, HSE no longer recommends the use of antidotes in the first-aid treatment of cyanide poisoning and does not require employers to keep supplies.
For information only - antidotes previously used were:
'solutions A and B' - (ferrous sulphate dissolved in aqueous citric acid, and aqueous sodium carbonate) given orally. A published review of the use of solutions A and B antidote questioned the efficacy of the solutions and drew attention to their inappropriate use. This antidote should not be used.
amyl nitrite - given by inhalation, is potentially dangerous, particularly in people with some forms of heart disease, although serious illness caused by misuse seems to be rare. It can be abused by 'sniffers' and has to be obtained on a medical prescription. It has a limited shelf life and can be difficult to obtain as it is manufactured only in small quantities. HSE will not recommend its use, but would not object if particular employers, after conducting a risk assessment, decided to maintain a supply.
intravenous dicobalt edetate (Kelocyanor) - has been proven to be of use when administered to seriously ill victims of confirmed cyanide poisoning. It is toxic, and can kill if used wrongly. Its administration is beyond the scope of first aid. Kelocyanor should only be used by medically qualified personnel when the diagnosis is certain and the patient is seriously ill. It should not be used by first aiders.
Employers should not routinely keep Kelocyanor at the workplace.
Nicholson P J, Ferguson-Smith J, Pemberton M A et al, 1994 Time to discontinue the use of solutions A and B as a cyanide 'antidote', Occup. Med. 44:125-128