Diferencia entre revisiones de «Hazmat exposure»

(Created page which provides an outline for Hazmat exposures presenting to the ED)
 
(Add verified PubMed reference (PMID 25455670))
 
(No se muestran 33 ediciones intermedias de 5 usuarios)
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==Background==
==Background==
*Definition - exposure to hazardous materials causing local/systemic toxicity.  
*Definition - exposure to hazardous materials causing local/systemic toxicity<ref>Borron SW. Checklists for hazardous materials emergency preparedness. Emerg Med Clin North Am. 2015 Feb;33(1):213-32. PMID 25455670</ref>


==Types of Injury==
===Types of Injury===
*Acids
*Acids
**cause coagulation necrosis which causes an eschar which often limits damage to deeper tissue.
**Cause coagulation necrosis which causes an eschar which often limits damage to deeper tissue
*Alkalis
*Alkalis
**cause liquefaction necrosis that penetrates into deeper tissue. *Other mechanisms: oxidation, protein denaturation, cellular dehydration, local ischemia.
**Cause liquefaction necrosis that penetrates into deeper tissue
*Other mechanisms: oxidation, protein denaturation, cellular dehydration, local ischemia
 
===Resources===
*Resources to determine what is in the offending agent:
**Poison control (800 222-1222)
**[http://www.msds.com/ Material Safety Data Sheet (MSDS)]
***Determines need for decon
**Chemical Transportation Emergency Center (Chemtrec) Emergency Telephone Number: (800) 424-9300
***Interntational and Maritime Telephone Number (collect calls accetped): +1 (703) 527-3887
**[https://toxnet.nlm.nih.gov/ TOXNET]


==History==
==Clinical Features==
===History===
*Route/duration of exposure
*Route/duration of exposure
*Often exposure in household, industry, agriculture, terrorism.
*Often exposure in household, industry, agriculture, or terrorism
*Identifying the chemical is paramount.
*Identifying the chemical is paramount


==Exam==
===Exam===
*Skin
*Skin
**Often appears deceptively normal initially
**Often appears deceptively normal initially
**Look for visible remaining liquid/powder on skin.
**Look for visible remaining liquid/powder on skin


*Membranes
*Membranes
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*Pulm
*Pulm
**Bronchospam/cough/pulm edema/cough
**Bronchospam/cough/pulmonary edema/cough


*Systemic sigs
*Systemic sigs
**AMS, seizures, tachy/brady dysrhythmias, hypo/hyper-tensive, GI sx, electrolyte abnormalitiyes, carboxyhemoglobinemia/methemoglobinemia, cyanide tox, toxidromic constellation of signs (e.g. cholinergic)
**altered mental status, seizures, tachy/brady dysrhythmias, hypo/hyper-tensive, GI sx, electrolyte abnormalitiyes, carboxyhemoglobinemia/methemoglobinemia, cyanide tox, toxidromic constellation of signs (e.g. cholinergic)


==Differential Diagnosis==


==Resources==
==Evaluation==
*Resources to determine what is in the offending agent:
**Poison control (800 222-1222)
**Material Safety Data Sheet (MSDS)
***Determines need for decon
***http://www.msds.com/
**Chemical Transportation Emergency Center (Chemtrec) Emergency Telephone Number: (800) 424-9300.  Interntational and Maritime Telephone Number (collect calls accetped): +1 (703) 527-3887
**TOXNET
***https://toxnet.nlm.nih.gov/
 
==Diagnostics==
*Work up based on chemical culprit
*Work up based on chemical culprit
*POC glucose
*POC glucose
*BMP Electrolytes, BUN, creatinine, and glucose levels *LFTs
*BMP  
*Calcium  
*Calcium  
*Magnesium
*Magnesium
*Phosphorus
*Phosphorus
*ABG - concern for metabolic acidosis, carboxyhemoglobinemias, methemoglobinemias  
*LFTs
*CXR - concern for pum edema
*VBG - concern for metabolic acidosis, carboxyhemoglobinemias, methemoglobinemias  
*[[CXR]] - concern for pulmonary edema


==Logistics==
==Management==
===Logistics===
*Establish Hazmat Plan
*Establish Hazmat Plan
**Affected patients need to stay in designated hot zones until decontaminated (staff can be injured secondary contamination inhalation of volatile gases).
**Affected patients need to stay in designated hot zones until decontaminated (staff can be injured secondary contamination inhalation of volatile gases)
**Patients may arrive by EMS, private vehicle, walk ins. Establish security perimeter to enforce hot zone.
**Patients may arrive by EMS, private vehicle, walk ins
**Establish security perimeter to enforce hot zone


*Protect yourself and staff
*Protect yourself and staff
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**Level D: Common work clothes
**Level D: Common work clothes


==Decon==
===Decontamination===
*Prehospital/In decon areas:
*Prehospital/In decon areas:
**Hydrotherapy - irrigate skin and ocular burns immediately and continuously (>15 min). Contraindicated only for elemental metals (Na, K).
**Hydrotherapy - irrigate skin and ocular burns immediately and continuously (>15 min)
***Contraindicated only for elemental metals (Na, K)
**Can allow patient to wash themselves if limited staff with protective gear
**Can allow patient to wash themselves if limited staff with protective gear
**Dispose of all clothes/bandages/IVs.
**Dispose of all clothes/bandages/IVs


==Management==
===Management===
*Aggressive supportive care, analgesia
*Aggressive supportive care, [[analgesia]]
*Antidote, if available
*[[Antidotes]] if available
*Pulm invovlement
*Pulmonary involvement
**[[O2]], [[albuterol]], [[intubation|intubate]]


**O2, albuterol, intbuate
===Specific Conditions===
==Specific Conditions==
*[[Chemical burns]]
*Chemical burns
**Strong alkali, needs irrigation for hours
**Strong alkali, needs irrigation for hours
**IVF 3cc/kg/TBSA, 1/2 given in first 8 hours
**IVF 3cc/kg/[[TBSA]], 1/2 given in first 8 hours
**Hydrofluoric acid burn
**[[Hydrofluoric acid]] burn
***Calcium gluconate via topic gel (10ml 10% sol'n applied topically), SC, or intra-arterial
***Calcium gluconate via topic gel (10ml 10% sol'n applied topically), SC, or intra-arterial
***IV calcium gluconate and magnesium for systemic toxicity
***IV calcium gluconate and magnesium for systemic toxicity
**Phenol burns
**Phenol burns
***polyethylene glycol 300 +/- isopropyl alcohol to remove phenol from skin
***Polyethylene glycol 300 +/- isopropyl alcohol to remove phenol from skin
**Nitrites
**Nitrites
***concern for methemoglobinemia
***Concern for [[Methemoglobinemia]]
***treat levels >30% w/ HF O2 and IV methylene  blue (1-2mg/kg slow IV, not recommended for <6 y/o, >6 y/o 1mg/kg IV/IM)
***Treat levels >30% with HF O2 and IV methylene  blue (1-2mg/kg slow IV, not recommended for <6 y/o, >6 y/o 1mg/kg IV/IM)
**Cyanide
**[[Cyanide]]
***Hydroxocobalamin (5mg IV /5 min, repeat once)
***[[Hydroxocobalamin]] (5mg IV /5 min, repeat once)
***Elemental metals (Na or K)
***Elemental metals (Na or K)
***water is contraindicated
***Water is contraindicated
***cover with oil under substance can be debrided from skin
***Cover with oil under substance can be debrided from skin
 
==Disposition==
*[[Burn center criteria|Transfer to burn center if criteria met]]
*Admit if systemic symptoms or airway concern
*Consider discharge of patients in consultation with poison control and/or after period of observation as needed


==See Also==
*[[Caustic burns]]
*[[Toxicology (Main)]]
*[[Weapon of mass destruction]]


==Disposition==
==External Links==
*Transfer to burn center (if meet criteria)
*[http://www.msds.com/ Material Safety Data Sheet (MSDS)]
*Admit if systemic sx, airway concern
*[https://toxnet.nlm.nih.gov/ TOXNET]
*Could d/c pts in consultation with poison control after period of obs.  


==References==
==References==
Schaider, Jeffrey. Rosen &Barkin's 5-Minute Emergent Medicine Consult
<references/>
 
[[Category:Toxicology]]

Revisión actual - 10:44 22 mar 2026

Background

  • Definition - exposure to hazardous materials causing local/systemic toxicity[1]

Types of Injury

  • Acids
    • Cause coagulation necrosis which causes an eschar which often limits damage to deeper tissue
  • Alkalis
    • Cause liquefaction necrosis that penetrates into deeper tissue
  • Other mechanisms: oxidation, protein denaturation, cellular dehydration, local ischemia

Resources

  • Resources to determine what is in the offending agent:
    • Poison control (800 222-1222)
    • Material Safety Data Sheet (MSDS)
      • Determines need for decon
    • Chemical Transportation Emergency Center (Chemtrec) Emergency Telephone Number: (800) 424-9300
      • Interntational and Maritime Telephone Number (collect calls accetped): +1 (703) 527-3887
    • TOXNET

Clinical Features

History

  • Route/duration of exposure
  • Often exposure in household, industry, agriculture, or terrorism
  • Identifying the chemical is paramount

Exam

  • Skin
    • Often appears deceptively normal initially
    • Look for visible remaining liquid/powder on skin
  • Membranes
    • Potential for airway compromise
    • Inspect eyes/nasopharynx/cornea if indicated
  • Pulm
    • Bronchospam/cough/pulmonary edema/cough
  • Systemic sigs
    • altered mental status, seizures, tachy/brady dysrhythmias, hypo/hyper-tensive, GI sx, electrolyte abnormalitiyes, carboxyhemoglobinemia/methemoglobinemia, cyanide tox, toxidromic constellation of signs (e.g. cholinergic)

Differential Diagnosis

Evaluation

  • Work up based on chemical culprit
  • POC glucose
  • BMP
  • Calcium
  • Magnesium
  • Phosphorus
  • LFTs
  • VBG - concern for metabolic acidosis, carboxyhemoglobinemias, methemoglobinemias
  • CXR - concern for pulmonary edema

Management

Logistics

  • Establish Hazmat Plan
    • Affected patients need to stay in designated hot zones until decontaminated (staff can be injured secondary contamination inhalation of volatile gases)
    • Patients may arrive by EMS, private vehicle, walk ins
    • Establish security perimeter to enforce hot zone
  • Protect yourself and staff
  • Personal chemical protective equipment:
    • Level A: Positive-pressure self-contained breathing apparatus (SCBA), fully encapsulated chemical-resistant suit, double chemical-resistant gloves, chemical-resistant boots, and airtight seals between suit, gloves, boots
    • Level B: SCBA, nonencapsulated chemical suit, double gloves, boots
    • Level C: Air-purification device, suit, gloves, boots
    • Level D: Common work clothes

Decontamination

  • Prehospital/In decon areas:
    • Hydrotherapy - irrigate skin and ocular burns immediately and continuously (>15 min)
      • Contraindicated only for elemental metals (Na, K)
    • Can allow patient to wash themselves if limited staff with protective gear
    • Dispose of all clothes/bandages/IVs

Management

Specific Conditions

  • Chemical burns
    • Strong alkali, needs irrigation for hours
    • IVF 3cc/kg/TBSA, 1/2 given in first 8 hours
    • Hydrofluoric acid burn
      • Calcium gluconate via topic gel (10ml 10% sol'n applied topically), SC, or intra-arterial
      • IV calcium gluconate and magnesium for systemic toxicity
    • Phenol burns
      • Polyethylene glycol 300 +/- isopropyl alcohol to remove phenol from skin
    • Nitrites
      • Concern for Methemoglobinemia
      • Treat levels >30% with HF O2 and IV methylene blue (1-2mg/kg slow IV, not recommended for <6 y/o, >6 y/o 1mg/kg IV/IM)
    • Cyanide
      • Hydroxocobalamin (5mg IV /5 min, repeat once)
      • Elemental metals (Na or K)
      • Water is contraindicated
      • Cover with oil under substance can be debrided from skin

Disposition

  • Transfer to burn center if criteria met
  • Admit if systemic symptoms or airway concern
  • Consider discharge of patients in consultation with poison control and/or after period of observation as needed

See Also

External Links

References

  1. ↑ Borron SW. Checklists for hazardous materials emergency preparedness. Emerg Med Clin North Am. 2015 Feb;33(1):213-32. PMID 25455670
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