poisonings-lecture_slides-Week1Part7.pdf

8/10/2019 poisonings-lecture_slides-Week1Part7.pdf

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Case Presentat ion - Decontaminat ion

Decontaminationo A 44 yo man spilled concentrated phenol on

his legs and did not wash it off immediately.

o In addition to chemical burns, he developedagitation, confusion, and seizures.


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Skin & Eyes

o Also common routes of workplace and homeexposure

o Significant potential disability / lost work

o Effects may be: local/corrosive (eg, chemical burns)

systemic (due to absorption across the skin)


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Some corros ives w/ systemic e f fects

Agent Systemic Toxicity

Formaldehyde metabolic acidosis (formate)

Hydrofluoric acid hypocalcemia, hyperkalemia

Permanganate methemoglobinemia

Phenol seizures, liver & kidney injury

Phosphorus liver & kidney injury

Silver nitrate methemoglobinemia


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Chol inesterase Inhibi tor Pest ic ides


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Secondary Contaminat ion

Substance is toxic

Is likely to be carried on victims

clothing, hair or skin in sufficient

amounts to threaten others

and


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Case Presentat ion The Toxic Mi x

The Toxic MixA 35 year-old female was cleaning her shower

and decided to use a mixture of bleach and a

lime scale remover. A greenish-yellow gasemerges, and the woman feels irritation in her

eyes and begins coughing repeatedly.


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Chemical Propert ies

o Bleach: NaOCl (sodium hypochlorite) pH = 10-12

Fumes typically release small amounts of

hypochlorous acid and chlorine gas- possible eye, throat irritation


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Mixing Household Agents

NaOCl + acid Cl2

bleach (e.g. vinegar, toilet bowl cleaners)

NaOCl + NH3 NH3Cl

ammonia chloramine


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Toxic i ty of Chlorine or Chloramine

o Ocular:irritation

o GI:nausea, vomiting, throat irritation

o Pulmonary:coughing, wheezing, stridor

symptoms may progress to bronchitis, chemical

pneumonitis; rarely, pulmonary edema


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Inhalat ion

o Common route of exposure in workplace andhome (sprays, burning)

o Units of exposure usually based on air

concentration:ppmor mg/M3

o Clinical effects may be

local/irritant (eg, chemical pneumonia) systemic (eg, CNS depression, hepatitis)


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Treatment

o Inhalation: Remove from source of exposure

- in most cases symptoms gradually resolve without

treatment

Humidified oxygen

Inhaled bronchodilators


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Treatment (cont d)

o Ingestion: dilution with fluids

o Ocular: irrigation

Fluorescein stain for persistent symptoms


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Case Fol low-up Night Surpr ise

o 60 year oldo Baking soda contains sodium bicarbonate. In

contact with acids, baking soda will generate agas causing stomach distention and vomiting.


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Handling a Poisoning Cal l (cont d)

Dont administer first-aid before calling unless:o the PC cant be contacted immediately, and

o you know it is appropriate.


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To i le t Bowl Cleaner Fir s t Aid

Recommendat ion

o If swallowed, do not induce vomiting. Call aphysician immediately. Drink large quantities

of milk or water, followed by several

tablespoonfuls of milk of magnesia or eggwhites..

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