Industrial & 'Cides Flashcards
CYANIDE
Ingested cyanide salts
Inhaled burning: wool, silk, rubber, synthetics
INHIBITS OXIDATIVE METABOLISM
Bitter almond odour
__________
R
- Usual
R
- ANY: potential for rapid death
- If arrive at hospital alive, should be okay
- Kids: can kill.
S
ANTICIPATE:
After LOC within seconds at the scene:
- UP symptoms (agitation, seizure, tachy, vomiting etc.), followed by - DOWN symptoms (coma, brady, hypoTN, resp depression)
- Tetany
-SUPPORT:
- 100% O2 (concurrent CO)
- Early intubation with ongoing 100% O2
I
- 12-lead, BGL, parac (delib)
- Cyanide levels no acute role
- ABG: Lactic acidosis, COHb
–> Lactate level correlates directly with severity
D
AC if ingested
PPE
WASH EVERYTHING: clothes, patient with soapy water. Bag clothes.
E
- No
A
(dicobalt, Na thiosulphate)
- HYDROXOCOBALAMIN 5g IV over 30 mins
–> ‘Cyanokit’ or would need 5k ampoules!
- Until better BP/ pH
D
OBSERVE 4 hours
Long term Parkinsonism
HYDROCARBONS
Eucalyptus oil, essential oils, turpentine, kerosine, toluene (glue), petrol
___________
R
- Usual
R
- Thicker = safer (motor oil, pertroleum jelly)
- Kids: “one sip can kill. 5ml eucalyptus oil is fatal.
S
ANTICIPATE:
- CNS depression (coma, seizure)
- Chemical asp pneumonitis from cough/gag
- Toluene (glue): nephrotoxic
-SUPPORT:
I
- 12-lead, BGL, parac (delib)
- CXR (aspiration)
D
- Avoid GI decontam: hydrocarbon asp risk++
- PPE
- Wash thoroughly patient, clothes with soapy water. Bag clothes.
E
No
A
No
D
OBSERVE 6 hours
HYDROFLUORIC ACID
Rust remover
Jewellery/ wheel cleaners
_________
R
- Usual
R
- Depends on %preparation
–> Ingestion
–> Large HFA burns
- Kids: any potentially lethal.
S
ANTICIPATE:
Inhaled: APO/pneumonitis
Ingested: GI corrosive
Dermal:
- Delayed deep, severe, out of proportion pain over hours
SYSTEMIC FLUOROSIS
Fluoride interferes with K+ channels and precipitates with Ca/Mg :
–> HypoCa, HypoMg, HyperK, acidosis
–> Arrhythmia
-SUPPORT:
Replenish Ca: CALCIUM GLUCONATE
- Fluorosis: 6g (100mg/kg kids) IV over 10 mins. Repeat Q5min until ionCa >1.1
- Burn: gel until pain better.
Replenish Mg: MgSO4
Sodi Bic if needed
I
- 12-lead, BGL, parac (delib)
- CMP 4 hourly
- Serial ECG (QTc)
D
No GI decontam: asp risk +
PPE
Thorough wash patient, bag clothes.
E
No
A
Calcium as above
D
OBSERVE 12 hours
ORGANOPHOSPHATES (+carbamates)
Pesticides
_________
R
- Usual
R
- All deliberate are potentially lethal
- Kids: “one sip can kill”
- Carbamates bit less lethal
Cholinergic: inhibits cholinesterase –> ACh +++. Musc and nicotinic.
S
ANTICIPATE:
Seizure, coma
Musc: DUMBELS
Nicont: FAT + weak.
Bradycardia
Resp failure from excessive secretions, and resp muscle paralysis
Musc: lacrim, saliv, bronchorrhoea, vomit, incont.
Nic: fascic, weakness, brady, resp paralysis
-SUPPORT:
- Early intubation
I
- 12-lead, BGL, parac (delib)
D
Doesn’t contaminate stsaff- universal precautions only
Thorough wash, bag clothes
AC: Not usually ingested. Try if within 1hr. No proven benefit.
E
No
A
High dose ATROPINE
1.2mg IV (50microg/kg kids). Double the dose Q5min. Infusion PRN.
–> TREATS AUTONOMICS (muscarinic), NOT PARALYSIS
AND
PRALIDOXIME 2g IV –> 500microg/hr. Continue min 24/24
–> Treats the PARALYSIS (nicotinic)
D
OBSERVE 12 hours
Sequelae:
- Ascending polyneuropathy
- Neuropsych
Prolonged paralysis if SUX used.
PARAQUAT
R
- Usual
R
- <10ml usually okay
- >50ml (20%) universally lethal
- Kids: one sip can kill.
S
ANTICIPATE:
<10ml: GI upset
10-50ml: Immediate GI corrosion then MODS within hours, and pulmonary fibrosis over days.
>50ml: lethal 1-7 days.
SUPPORT:
- PALLIATE large, deliberate ingestions
- Avoid O2 unless hypoxic. Target 90%. (free radicals).
I
- 12-lead, BGL, parac (delib)
- Lactate >4.4 = fatal.
- Dithiontite test - quick confirmation
- Serum paraquat: quantitative/ prognostic.
D
Only time DECONTAMINATION+++ takes priority over resus
–> Food/soil at scene
–> AC in ED
E
Haemodialysis or VA ECMO (best in 2 hours)
A
No
D
OBSERVE 6-12 hours
