• amyl nitrite
• cyanide poisoning

The traditional method of administering amyl nitrite to a victim of cyanide poisoning, is to break an ampoule in a handkerchief and then intermittently hold this under the victim’s nose.^1,2

I would like to suggest two alternative methods for administering amyl nitrite. The first method is to use a nebuliser. The second method is to use an inhaler similar to the Penthrox device, normally used to administer methoxyflurane for emergency analgesia.

With appropriate training, either method could be used by first aid staff. This could be of particular value to remote mine sites where the absence of medical staff may preclude intravenous administration of cyanide antidotes such as dicobalt edetate, sodium thiosulphate, sodium nitrite, or hydroxocobalamin.

Both methods offer the following advantages over the traditional method:

• Oxygen can be administered during treatment

• Rapid delivery of the drug

• Accurate dose delivery

• Less risk of inhalation by first aid or medical staff

• Less risk of injury due to glass fragments.

The inhaler device would also be particularly well suited to the treatment of large numbers of victims following industrial disaster or terrorist attack—the risk of which has been recently alluded to.³

One concern about introducing these methods is the potential for amyl nitrite toxicity. Experimental research is recommended to determine safe dosages and frequencies for each method.