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Writer's pictureDavid Arbona, MD

Pre-Hospital Interventions: Methylene Blue & Sodium Nitrate Overdose

� Can prehospital administration of methylene blue improve survival in cases of massive sodium nitrite overdose?


Sodium nitrite overdose leads to severe methemoglobinemia and can be rapidly fatal. A recent case study highlights the potential life-saving role of methylene blue when administered early by EMS.


� Study Insights:


➊ Case Report:

A 31-year-old woman ingested a large quantity of sodium nitrite in a suicide attempt. Despite a prompt EMS response, she experienced rapid clinical decline, resulting in cardiac arrest before reaching the hospital.


➋ Clinical Course:

After initial contact by EMS the patient was alert but showing signs of methemoglobinemia (84% SpO2 with cyanosis).


Rapid deterioration:

Within 40 minutes of ingestion, the patient went into cardiac arrest.


EMS interventions included supplemental oxygen, midazolam for seizures, and attempts at airway management.


Hospital arrival:

Despite aggressive resuscitation efforts, the patient died. Postmortem methemoglobin level was 84.4%.


➌ Protocol Development:

Following this case, Hennepin EMS developed a protocol for prehospital methylene blue administration.


Methylene blue will be stored in EMS supervisor vehicles for rapid on-scene availability.


Training and guidelines have been established for EMS personnel on methylene blue administration.


� Conclusions:

Early administration of methylene blue in the prehospital setting could significantly improve survival in sodium nitrite overdose cases.


Implementation of this protocol represents a critical step in enhancing EMS capabilities to manage severe methemoglobinemia effectively.


� For more detailed findings, read the full study: https://ow.ly/vXFC50ShBri

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