TOXIC GASES

Question 1

What is paramount in the initial approach to any toxic inhalation situation?

Answer 1

Scene Safety

Question 2

What is mandatory when managing patients with toxic inhalations?

Answer 2

PPE (Self-contained breathing apparatus)
and
Decontamination

Question 3

Toxic Inhalations:

Once the patient is safely accessible for the IDC, the mainstay of patient treatment is _____________.

Answer 3

Supportive care with:

1) High flow 100% O2
2) BVM ventilation
3) Endotracheal intubation (ETI) as needed

Question 4

Inhaled agents manifest their toxic effects by what four different mechanisms?

Answer 4

1) Physical particulates
2) Simple asphyxiants
3) Chemical irritants
4) Chemical asphyxiants

Question 5

What are small, solid particles that are carried by gases or atmospheric air into the body through inhalation (e.g., dust or combustion soot)?

Answer 5

Physical Particulates

Question 6

What are the signs and symptoms of physical particulate exposure?

Answer 6

1) Excessive Coughing

2) Shortness of Breath

Question 7

What is the treatment for a patient that has been exposed to physical particulates?

Answer 7

1) Remove patient from source
2) Administer O2
3) Patients with signs of reactive airway disease (e.g., wheezing and poor air flow) should be treated with NEBULIZED Albuterol.

Question 8

___________ cause injury by merely being present in an environment and displacing the normal levels of atmospheric oxygen.

Answer 8

Simple Asphyxiants

Question 9

What gases are Simple Asphyxiants?

Answer 9

1) Carbon dioxide (CO2),
2) Nitrogen,
3) Methane,
4) Natural gas

Question 10

If a patient has burns on their face, and soot around their mouth, what mechanism of inhaled agent were they most likely exposed to?

Answer 10

Physical Particulates

Question 11

How do Simple Asphyciants effect the body?

Answer 11

Causing hypoxia by pushing normal oxygen out of the lungs

Question 12

What are the signs and symptoms of exposure to a simple asphyxiant?

Answer 12

Signs of Hypoxia like:

1) Agitation
2) Unconsciousness
3) Cardiac Arrest

Question 13

Patients may experience a narcotic-like sleepiness as the initial effect of exposure to what type of simple asphyxiant?

Answer 13

CO2 (Carbon Dioxide)

Question 14

What is the treatment of Simple Asphyxiant exposure?

Answer 14

1) Gain safe access to patient
2) High concentration O2
3) Cardiopulmonary support as indicated

Question 15

The mainstay of simple asphyxiant management is ____________________________.

Answer 15

Gaining safe access to patient

Question 16

__________________express their toxic effects by chemical reaction with the mucus membranes of the eyes and respiratory system

Answer 16

Chemical Irritants

Question 17

What are the two general classes of chemical irritants?

Answer 17

1) React with water

2) Do not react with water

Question 18

Chemical irritants that are highly reactive with water are called ____________.

Answer 18

Hydrophilic

Question 19

What are the two types of Hydrophilic agents?

Answer 19

Hydrochloric acid

Ammonia

Question 20

What type of agents react quickly with the moist membranes of the eyes and the upper respiratory tree, causing immediate intense burning and pain?

Answer 20

Hydrophilic Chemical Irritant

Question 21

What is an example of a non- hydrophilic chemical irritant?

Answer 21

Phosgene Gas

Question 22

What is the treatment of chemical irritant exposure?

Answer 22

1) Supportive care
2) Irrigation of eyes with water or saline
3) Nebulized albuterol treatments if bronchospasm

Question 23

_____________ cause injury by asphyxiating patients at the cellular level by massively deranging normal cellular utilization of oxygen.

Answer 23

Chemical Asphyxiants

Question 24

What is the most common example of Chemical Asphyxiants?

Answer 24

Carbon Monoxide (CO)

Question 25

What product of combustion, rapidly displaces oxygen from the hemoglobin, forming carboxyhemoglobin (COHgb)?

Answer 25

Carbon Monoxide (CO)

Question 26

What are examples of inhaled chemical asphyxiants?

Answer 26

1) Carbon Monoxide (CO)
2) Cyanide Gas (HCN)
3) Hydrogen Sulfide (H2S)

Question 27

What type of chemical asphyxiant exposure often has a gradual, even insidious, onset of symptoms,which may include headache, chest pain and decreasing mental status?

Answer 27

Carbon Monoxide (CO)

Question 28

What type of chemical asphyxiant exposure tends to have a very rapid onset and progression of symptoms?

Answer 28

1) Cyanide Gas (HCN)

2) Hydrogen Sulfide (H2S)

Question 29

What is the treatment for Carbon Monoxide (CO) poisoning?

Answer 29

High-flow oxygen via a non-rebreather mask
or
ET tube for a comatose patient.

Question 30

What chemical asphyxiant exposure patients are candidates for hyperbaric oxygen therapy?

Answer 30

1) High blood levels of COHgb
2) Pregnant
3) Cardiac Ischemia
4) Loss of conciousness

Question 31

What chemical has a “Rotten Egg” smell?

Answer 31

Hydrogen Sulfide (H2S)

Question 32

What is important to remember when treating a patient with Hydrogen Sulfide (H2S) exposure?

Answer 32

The “off ventilation” of exhaled H2S from the contaminated patient’s may effect the provider

adequate ventilation of the patient compartment during transport is essential.

Question 33

What is essential during the transportation of a patient that was exposed to Hydrogen Sulfide (H2S)?

Answer 33

Adequate ventilation of the patient compartment

Question 34

What advanced therapies should be used for Hydrogen Sulfide (H2S) exposed patients?

Answer 34

1) The Nitrite component of the standard cyanide kit

2) Hyperbaric oxygen therapy

Question 35

How would a seriously poisoned cyanide victim classically present?

Answer 35

Unresponsiveness,

Hyperventilation

And Hypotension WITHOUT Cyanosis.

Question 36

What is the treatment for cyanide posioning?

Answer 36

Cyanide Antidote Therapy:

IN THIS ORDER-

1) Inhaled amyl nitrite
2) IV sodium nitrite and
3) IV sodium thiosulfate

OR

IV hydroxocobalamin, combined with sodium thiosulfate

PLUS

100% Oxygen

Question 37

What are the drugs (in order) for Cyanide Antidote Therapy?

Answer 37

1) Inhaled amyl nitrite
2) IV sodium nitrite and
3) IV sodium thiosulfate