First aid for cyanide exposure

April 2022

Cyanide poisoning

Cyanide compounds are very toxic to humans and inhalation exposure can be rapidly fatal. Cyanide compounds prevent the transfer of oxygen from the blood to body tissues as a result of selective inhibition of respiratory enzymes. The heart and central nervous system are particularly prone to rapid damage. Cyanides can enter the body by inhalation, by contact with the skin or eyes and if swallowed (ingestion).

Although cyanide poisoning is uncommon, all staff and students working with or studying in areas using or storing cyanide must be familiar with the first aid required for cyanide poisoning. The most likely injury is to the person using the material but production of hydrogen cyanide gas in an open laboratory could have serious consequences for all occupants. The critical factor is the speed with which the first aid can be started after exposure.

Symptoms of cyanide poisoning

First aid provisions when using cyanide

Where cyanide is used, a risk assessment should be undertaken to determine if medical oxygen is required.  First Aiders must have completed basic oxygen administration training (22298VIC Course in Basic Oxygen Administration).  All oxygen cylinders must be maintained according to the First Aid Procedure.

First aid for cyanide exposure

Speed is essential - treatment must be prompt to be effective

First aid assistance should only be rendered if there is no suspected cyanide gas/dust in the immediate environment.

If cyanide gas/dust is suspected:

• Do not enter the area
• Contact Emergency Services on (0) 000 from a Monash internal phone line or 112 from a mobile
• Call Security on 333
• Double glove to avoid contamination from patient's skin and clothes

If the casualty is conscious:

• Administer medical oxygen at the maximum rate via a resuscitation mask
• Remove contaminated clothing and place in biohazard bag labelled "Contaminated with Cyanide" until they can be decontaminated
• Wash all contaminated skin with copious amounts of water for at least 20 minutes
• Continue treatment until medical assistance arrives

If the casualty is not conscious:

• Check airway and clear if necessary (use nitrile gloves as above)

If the casualty is breathing:

• Place the person on their side
• Administer medical oxygen at the maximum rate via a resuscitation mask
• Remove contaminated clothing and place in a biohazard bag labelled "Contaminated with Cyanide" until they can be decontaminated
• Wash all contaminated skin with copious amounts of water for at least 20 minutes
• Continue treatment until medical assistance arrives

If the casualty is not breathing:

• Check airway and clear if necessary (use nitrile gloves as above)

Do not use mouth to mouth or mouth to nose resuscitation, due to risk of contamination.

• Administer medical oxygen at the maximum rate via a resuscitation mask
• Remove contaminated clothing and place in a biohazard bag labelled '"Contaminated with Cyanide" until they can be decontaminated
• Begin chest compressions
• Wash all contaminated skin with copious amounts of water for at least 20 minutes
• Continue treatment until medical assistance arrives

In all cases, a copy of the applicable cyanide safety data sheet (SDS) should accompany the patient to hospital.

The affected person's supervisor should be notified immediately.

A first aid report and hazard & incident report should be completed as soon as possible.

For disposal of contaminated clothing, refer to Using Chemicals at Monash University.

First Aid Kit - Cyanide Module

Refer to the First Aid Procedure and the First Aid Kit Contents List.

The first aid kit containing this module must be marked as follows “THIS KIT CONTAINS A CYANIDE MODULE”

This module should be clearly marked in a separate container and be readily accessible to the area where cyanide is used. It should be located adjacent to the first aid kit and medical oxygen.

NOTE: If casualty is not breathing, DO NOT USE MOUTH TO MOUTH RESUSCITATION because of the danger to the rescuer.  Use a resuscitator set (bag, valve and mask) instead.

Contents of module:

• Copy of this OHS Information Sheet (First Aid For Cyanide Exposure)
• Copy of the applicable cyanide safety data sheet
• Copy of the National Occupational Health and Safety Commission Cyanide Poisoning Guide (March 1993)
• Medical oxygen (1 bottle)
• Disposable, single-use resuscitator set (e.g. Laerdel^® or Ambu^®), including a bag, valve and mask (1)
• Nitrile gloves (8 pairs)
• Safety goggles or glasses (2 pairs)
• Stainless steel first aid shears (1)
• Biohazard bags labelled with "Contaminated with Cyanide" (2)

Further information and advice

Occupational Health & Safety:

• Telephone: 990 51016
• Email: ohsehelpline@monash.edu

Poisons Information Centre Victoria:

• Telephone: 131 126 (24 hours)