If hydroxocobalamin is not readily available, should you delay transport to obtain it?

• A. YES, delay transport until medication is obtained
• B. NO, do not delay transport
• C. Only if the patient is unstable
• D. Delay only if there is time

Answer: (B)

The main idea being tested is that in time‑critical poisoning, you should not delay transport to obtain an antidote. Cyanide poisoning can cause rapid tissue hypoxia, so getting the patient to definitive care and continuing supportive treatment is the priority, even if hydroxocobalamin isn’t immediately available.

Hydroxocobalamin is a specific antidote, but waiting on it can let the patient’s condition deteriorate. You should maintain airway, give high‑flow oxygen, establish IV access, and begin rapid transport to a facility where antidote can be given or where definitive care is available. If possible, coordinate with base hospital or the receiving facility to have hydroxocobalamin available upon arrival, but do not stall transport to obtain it.

Delaying transport to obtain the antidote would put the patient at greater risk of ongoing hypoxia and worsening lactic acidosis, which is why the best option is to proceed with transport and provide supportive care now.