Aug. 18, 2003
John F. Sorrell, MD, FACEP, and Ralph M. Shealy, MD, FACEP
Medical Directors
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Methemoglobinemia due to exposure to oxidizing agents, such as nitrates, characterized by cyanosis unresponsive to oxygen and chocolate brown blood.
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Use PPE to prevent exposure to toxin.
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Remove to a non-contaminated environment.
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Rapidly decontaminate patient to prevent further absorption of toxin.
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Administer high flow oxygen by non-rebreather mask.
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If patient is not ventilating adequately, assist respirations with bag-valve-mask.
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Establish intravenous access.
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Cardiac monitor, blood pressure monitor, pulse oximeter.
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Administer Methylene Blue 1 mg/kg IV or IO (slowly, over 10-15 minutes) .
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Contact Medical Control.
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