Inhalational injuries H.R.Sarreshtahdar , MD Occupational Medicine Specialist
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Inhalational Inhalational injuriesinjuries
H.R.Sarreshtahdar, MDH.R.Sarreshtahdar, MDOccupational Medicine SpecialistOccupational Medicine Specialist
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Irritant lung reactionsIrritant lung reactions Many gases, fumes, and aerosols are
directly toxic to the respiratory tract Site of effect is determined by:
Water solubility High solubility (ammonia): irritation of upper
respiratory Low solubility (O3): irritation of lower respiratory
Particle size Large particles (>10μm): upper respiratory Medium particles (3-10 μm): airways Small particles (<3 μm): lung parenchyma
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Irritant lung reactionsIrritant lung reactions Examples of some irritants:
Ammonia HCl SO2 NOx Phosgene O3
Clinical findings: Immediate irritation of upper respiratory tract
to late pneumonitis and pulmonary edema
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ManagementManagement Immediately obtain ABG + O2 therapy Take a history (esp. attention to chemical
asphyxiants) Examine eyes, nose, pharynx for evidence of
burns Auscultate lungs Baseline spirometry if subject is capable Baseline CXray Admit to hospital Observe for 24-48h
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Simple AsphyxiantsSimple Asphyxiants Gases:
Methane, ethane, propane Ethylene, propylene, acethylene CO2 N2 NO
Effect: reduction of fractional inspiratory concentration of O2→ hypoxia
No toxic effects
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Simple AsphyxiantsSimple Asphyxiants Exposure:
typically in confined spaces (storage tanks, mines)
For gases heavier than air any low-lying semi-closed space with little air movement is dangerous
Methane (mining)CO2 (food preservation, manufacture of dry ice,
…)N2 (underwater work, mining, metallurgic
operations, pressurizing oil wells)
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Simple AsphyxiantsSimple Asphyxiants Clinical findings: Related on:
Asphyxiant concentration Level of physical activity Underlying medical status
Normal air O2: 21% O2 (10-16%): tachycardia, tachypnea,
exercise intolerance O2 (6-10%): nausea, prostration, coma O2 (<6%): rapid loss of consciousness
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Simple AsphyxiantsSimple Asphyxiants
Treatment
Immediate removal from exposure
Supportive measures (esp. supplemental
O2)
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Toxic AsphyxiantsToxic AsphyxiantsInhalation of asphyxiants which have toxicity to tissues
Carbon monoxide (CO)
Hydrogen cyanide (HCN)
Hydrogen sulfide (H2S)
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COCO An odorless, colorless gas CO intoxication: the leading cause of
death from gas inhalation Exposure:
Incomplete combustion of fuels (vehicles, forklifts, generators, … esp. when used indoors)
Jobs: Firefighters, petroleum refinery workers,
furnace operators, …
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COCO Mechanism of action:
Binding to Hgb (COHb):
↓ O2 binding capacity
Leftward shift of O2 dissociation curve
Binding to cytochrome oxidase:
Compromising cellular respiration Clinical findings:
Headache, nausea, vomiting, malaise, loss of consciousness, coma, death, cardiac ischemia
Lab data: ↑ COHb in cooximetry Routine ABG is not helpful EKG (MI without typical chest pain)
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COCOTreatment
Immediate removal from exposure
100% O2
Hyperbaric oxygen
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HCNA colorless gas with bitter almond odorUses:
metal plating, and extraction of silver and gold salts from ores
Exposure: thermolysis byproduct of many polymers
Jobs: Pesticide workers, printing, soldering,
firefighting, photography, paper production,… Mechanism of action:
Binding to cytochrome oxidaseClinical findings:
Dyspnea, dizziness, headache, confusion, loss of consciousness, coma, death
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HCN
Lab findings: Blood cyanide level (not available) Urine thiocyanate (not reliable)
Treatment: Removal of exposure Induction of metHgb (300 mg Na nitrite) Detoxification of cyanide (sodium
thiosulfate) Supportive measures
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H2SA colorless gas with rotten egg odorExposure:Many jobs (petroleum production and refinery, farming, chemical laboratory, excavators, fish processing, sewage workers,…Mechanism of action:
Binding to cytochrome oxidase Irritant effect on mucous membranes
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H2S Clinical findings:
Irritant findings: airway irritation, burning eyes
Headache, dizziness, nausea and vomiting
Dermatitis, pneumonitis, pulmonary edema
loss of consciousness, coma, death Lab data:
Blood sulfide level Treatment:
Removal of exposure
Induction of metHgb (300 mg Na nitrite)
Supportive measures