<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 36-year-old male with fluctuating levels of consciousness is brought to the emergency department by ambulance due to a fire in his home. He currently opens his eyes to voice, localizes painful stimuli, responds when asked questions, but is disoriented and cannot obey commands. The patients temperature is 99F 37.2C, blood pressure is 8652 mmHg, pulse is 88min, and respirations are 14min with an oxygen saturation of 97 O2 on room air. Physical exam shows evidence of soot around the patients nose and mouth, but no burns, airway obstruction, nor accessory muscle use. A blood lactate is 14 mmolL. The patient is started on intravenous fluids.What is the next best step in management?? A: Methylene blue, B: Hyperbaric oxygen, C: Intravenous epinephrine, D: Sodium thiosulfate and sodium nitrite, E: 100 oxygen, hydroxycobalamin, and sodium thiosulfate,  <response>: This is a question about the management of cyanide poisoning. The key findings in the stem are fluctuating consciousness, elevated lactate, and smoke inhalation, which are suggestive of cyanide toxicity. The choices include antidotes for cyanide poisoning. Methylene blue inhibits the action of cytochrome oxidase, which is the enzyme cyanide inhibits. Hyperbaric oxygen increases oxygen delivery. Epinephrine is used for hemodynamic support. Sodium thiosulfate converts cyanide to thiocyanate, while sodium nitrite converts hemoglobin to methemoglobin which binds cyanide. Hydroxycobalamin binds and inactivates cyanide.E: 100 oxygen, hydroxycobalamin, and sodium thiosulfate 