Immediate - Unconscious/seizures, apnea, severe airway, GI or skeletal muscle involvement. Generally a person exposed to a lethal amount of cyanide will die within 5 to 10 minutes of exposure. High concentrations of cyanide gas can cause death in minutes however, low concentrations may produce symptoms gradually, causing challenges for the triage officer. A comprehensive source for the selection of chemical identification equipment is the Guide for the Selection of Chemical Detection Equipment for Emergency First Responders, Guide 100-06, January 2007, 3rd Edition published by the Department of Homeland Security to assist with this process.Devices - M256A1 chemical agent detector kit (liquid and vapor), Chemical Agent Detector C2 Kit (liquid and vapor), M18A3, M90 chemical agent detectors (vapor), Draeger CDS Kit (vapor and aerosol), M272 chemical water testing, Hazmat Smart Strips (qualitative).Identification Tools - CHEMM-IST, WISER, Cyanide Chemical Properties.General information on these identification technicques is located in Emergency Response Guidebook. Responders should obtain assistance in identifying the chemical(s) from container shapes, placards, labels, shipping papers, and analytical tests.Liquid agent, which is readily absorbed through skin ( especially in young children and pregnant women) can produce symptoms immediately or be delayed up to an hour).With lower dose exposures signs and symptoms may take longer to present. The time of onset of symptoms typically is seconds following inhalation of higer doses of gaseous hydrogen cyanide and may cause abrupt onset of profound CNS, cardiovascular, and respiratory effects, leading to death within minutes.The amount of cyanide, the duration of exposure, the route of exposure all influence the time to onset and the severity of illness.
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