Valencia College West Paramedics 2011-2012

The Florida Department of Health has reported the first measles case in Central Florida this year, with Osceola County resident as the patient. This marks the second measles case in the county since 1992. Florida has recorded the third highest number of measles cases in the US this year.
at.wftv.com/4s2UGN8

𝐒𝐮𝐢𝐜𝐢𝐝𝐞 𝐤𝐢𝐭𝐬 are becoming more prevalent.

Clinicians need to know what this poisoning looks like and how to treat it in the field.

Your patient is cyanotic, unresponsive, and not improving with 100% oxygen. The pulse ox reads 85%… but the blood in the IV line looks dark brown.

𝐖𝐡𝐚𝐭'𝐬 𝐠𝐨𝐢𝐧𝐠 𝐨𝐧?
A recently published case report highlights a rare but increasingly recognized toxicologic emergency: 𝐬𝐨𝐝𝐢𝐮𝐦 𝐧𝐢𝐭𝐫𝐢𝐭𝐞 𝐩𝐨𝐢𝐬𝐨𝐧𝐢𝐧𝐠 𝐜𝐚𝐮𝐬𝐢𝐧𝐠 𝐬𝐞𝐯𝐞𝐫𝐞 𝐦𝐞𝐭𝐡𝐞𝐦𝐨𝐠𝐥𝐨𝐛𝐢𝐧𝐞𝐦𝐢𝐚, and the lifesaving role EMS can play by administering methylene blue in the prehospital setting.

𝐓𝐡𝐞 𝐂𝐚𝐬𝐞:
An 18-year-old male was found unconscious at home with profound cyanosis and vomiting.
On ALS arrival: GCS of 4, severe dyspnea, SpO₂ ~85% despite 100% oxygen.

Naloxone and flumazenil had no effect.

During IV access, clinicians noticed dark "chocolate-colored" blood, a classic clue for methemoglobinemia.

This is a condition where hemoglobin is oxidized and unable to carry oxygen effectively, causing severe tissue hypoxia even when PaO₂ is normal.

𝐓𝐡𝐞 𝐒𝐚𝐯𝐞
The ALS team recognized the pattern and administered methylene blue in the field, the antidote that converts methemoglobin back into functional hemoglobin. The patient was intubated and transported.

In the ED, blood gas confirmed methemoglobinemia at 30%. After a second dose of methylene blue, levels dropped from 30% to 8% within five minutes. The patient was extubated in six hours and discharged the next day without complications.

The first methylene blue dose was given approximately 15 minutes after EMS arrival. That speed likely prevented a fatal outcome.

𝐓𝐡𝐞 𝐒𝐲𝐬𝐭𝐞𝐦 𝐁𝐞𝐡𝐢𝐧𝐝 𝐭𝐡𝐞 𝐒𝐚𝐯𝐞
This wasn't luck. After previous sodium nitrite deaths in the region, ALS units were proactively equipped with methylene blue, allowing field physicians to treat suspected methemoglobinemia immediately. That's what system-level preparedness looks like.

𝐊𝐞𝐲 𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐂𝐥𝐮𝐞𝐬 𝐟𝐨𝐫 𝐄𝐌𝐒:
Persistent cyanosis with SpO₂ ~85–89% despite high-flow O₂, chocolate-colored blood, and hypoxia that doesn't correlate with oxygen delivery should raise immediate suspicion for methemoglobinemia.

𝐁𝐨𝐭𝐭𝐨𝐦 𝐋𝐢𝐧𝐞:
As sodium nitrite su***de kits become more accessible, EMS systems need both the awareness and the antidote on the truck. Early recognition and prehospital methylene blue can be the difference between life and death.

📚 Read the Full Study:https://media.handtevy.com/website/Early-Recognition-and-Management-of-Severe-Sodium-Nitrite-Intoxication-A-Case-Report-Emphasizing-Prehospital-Administration-of-Methylene-Blue.pdf

https://www.facebook.com/share/p/1H6pqGqc7s/?mibextid=wwXIfr

Why not the infidelity lounge?

To all first responders, thank you for your service! Your commitment protects our community, now let us treat you 💙

We’re proud to offer one FREE ticket for you, plus special savings for your family & friends at !

Be sure to register by Oct 31 and visit by Dec 31: http://spklr.io/6189BKIvW

Mark your calendars! 📅 On September 12, we’re honoring our community heroes with FREE admission for all first responders at the Zoo! 🐾

This offer includes law enforcement officers, EMTs/paramedics, and fire department personnel. Show proof of employment at the gate to redeem. Onsite only.

To make the day even more special, from 9 to 10:30 a.m., we’ll welcome members from local first responder teams! Guests can meet these heroes, check out their equipment, and enjoy fun giveaways for kids.

Join us!