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0.2.1 SUMMARY OF EXPOSURE
0.2.1.1 ACUTE EXPOSURE
A) A SPECIFIC REVIEW on the clinical effects and treatment
of individuals exposed to this agent HAS NOT YET BEEN
PREPARED. The following pertains to the GENERAL
EVALUATION and TREATMENT of individuals exposed to
potentially toxic chemicals.
B) GENERAL EVALUATION -
1) Exposed individuals should have a careful, thorough
medical history and physical examination performed,
looking for any abnormalities. Exposure to chemicals
with a strong odor often results in such nonspecific
symptoms as headache, dizziness, weakness, and nausea.
C) IRRITATION -
1) Many chemicals cause irritation of the eyes, skin, and
respiratory tract. In severe cases respiratory tract
irritation can progress to ARDS/acute lung injury,
which may be delayed in onset for up to 24 to 72 hours
in some cases.
2) Irritation or burns of the esophagus or
gastrointestinal tract are also possible if caustic or
irritant chemicals are ingested.
D) HYPERSENSITIVITY -
1) A number of chemical agents produce an allergic
hypersensitivity dermatitis or asthma with
bronchospasm and wheezing with chronic exposure. |
A) A number of chemicals produce abnormalities of the
hematopoietic system, liver, and kidneys. Monitoring
complete blood count, urinalysis, and liver and kidney
function tests is suggested for patients with significant
exposure.
B) If respiratory tract irritation or respiratory depression
is evident, monitor arterial blood gases, chest x-ray,
and pulmonary function tests. |
0.4.2 ORAL EXPOSURE
A) GASTRIC LAVAGE
1) Significant esophageal or gastrointestinal tract
irritation or burns may occur following ingestion. The
possible benefit of early removal of some ingested
material by cautious gastric lavage must be weighed
against potential complications of bleeding or
perforation.
2) GASTRIC LAVAGE: Consider after ingestion of a
potentially life-threatening amount of poison if it can
be performed soon after ingestion (generally within 1
hour). Protect airway by placement in the head down
left lateral decubitus position or by endotracheal
intubation. Control any seizures first.
a) CONTRAINDICATIONS: Loss of airway protective reflexes
or decreased level of consciousness in unintubated
patients; following ingestion of corrosives;
hydrocarbons (high aspiration potential); patients at
risk of hemorrhage or gastrointestinal perforation;
and trivial or non-toxic ingestion.
B) ACTIVATED CHARCOAL
1) Activated charcoal binds most toxic agents and can
decrease their systemic absorption if administered soon
after ingestion. In general, metals and acids are
poorly bound and patients ingesting these materials
will not likely benefit from activated charcoal
administration.
a) Activated charcoal should not be given to patients
ingesting strong acidic or basic caustic chemicals.
Activated charcoal is also of unproven value in
patients ingesting irritant chemicals, where it may
obscure endoscopic findings when the procedure is
justified.
2) ACTIVATED CHARCOAL: Administer charcoal as a slurry
(240 mL water/30 g charcoal). Usual dose: 25 to 100 g
in adults/adolescents, 25 to 50 g in children (1 to 12
years), and 1 g/kg in infants less than 1 year old.
C) DILUTION -
1) Immediate dilution with milk or water may be of benefit
in caustic or irritant chemical ingestions.
2) DILUTION: If no respiratory compromise is present,
administer milk or water as soon as possible after
ingestion. Dilution may only be helpful if performed in
the first seconds to minutes after ingestion. The ideal
amount is unknown; no more than 8 ounces (240 mL) in
adults and 4 ounces (120 mL) in children is recommended
to minimize the risk of vomiting.
D) IRRITATION -
1) Observe patients with ingestion carefully for the
possible development of esophageal or gastrointestinal
tract irritation or burns. If signs or symptoms of
esophageal irritation or burns are present, consider
endoscopy to determine the extent of injury.
E) OBSERVATION CRITERIA -
1) Carefully observe patients with ingestion exposure for
the development of any systemic signs or symptoms and
administer symptomatic treatment as necessary.
2) Patients symptomatic following exposure should be
observed in a controlled setting until all signs and
symptoms have fully resolved.
0.4.3 INHALATION EXPOSURE
A) DECONTAMINATION -
1) INHALATION: Move patient to fresh air. Monitor for
respiratory distress. If cough or difficulty breathing
develops, evaluate for respiratory tract irritation,
bronchitis, or pneumonitis. Administer oxygen and
assist ventilation as required. Treat bronchospasm with
an inhaled beta2-adrenergic agonist. Consider systemic
corticosteroids in patients with significant
bronchospasm.
B) IRRITATION -
1) Respiratory tract irritation, if severe, can progress
to pulmonary edema which may be delayed in onset up to
24 to 72 hours after exposure in some cases.
C) ACUTE LUNG INJURY -
1) ACUTE LUNG INJURY: Maintain ventilation and oxygenation
and evaluate with frequent arterial blood gases and/or
pulse oximetry monitoring. Early use of PEEP and
mechanical ventilation may be needed.
D) BRONCHOSPASM -
1) If bronchospasm and wheezing occur, consider treatment
with inhaled sympathomimetic agents.
E) OBSERVATION CRITERIA -
1) Carefully observe patients with inhalation exposure for
the development of any systemic signs or symptoms and
administer symptomatic treatment as necessary.
2) Patients symptomatic following exposure should be
observed in a controlled setting until all signs and
symptoms have fully resolved.
0.4.4 EYE EXPOSURE
A) DECONTAMINATION: Remove contact lenses and irrigate
exposed eyes with copious amounts of room temperature
0.9% saline or water for at least 15 minutes. If
irritation, pain, swelling, lacrimation, or photophobia
persist after 15 minutes of irrigation, the patient
should be seen in a healthcare facility.
0.4.5 DERMAL EXPOSURE
A) OVERVIEW
1) DERMAL DECONTAMINATION -
a) DECONTAMINATION: Remove contaminated clothing and
jewelry and place them in plastic bags. Wash exposed
areas with soap and water for 10 to 15 minutes with
gentle sponging to avoid skin breakdown. A physician
may need to examine the area if irritation or pain
persists (Burgess et al, 1999).
2) PESTICIDES -
a) DECONTAMINATION: Remove contaminated clothing and
jewelry and place them in plastic bags. Wash exposed
areas with soap and water for 10 to 15 minutes with
gentle sponging to avoid skin breakdown. A physician
may need to examine the area if irritation or pain
persists (Burgess et al, 1999).
3) IRRITATION -
a) Treat dermal irritation or burns with standard topical
therapy. Patients developing dermal hypersensitivity
reactions may require treatment with systemic or
topical corticosteroids or antihistamines.
4) DERMAL ABSORPTION -
a) Some chemicals can produce systemic poisoning by
absorption through intact skin. Carefully observe
patients with dermal exposure for the development of
any systemic signs or symptoms and administer
symptomatic treatment as necessary. |
Env. Health & Toxicology
