Hydrocarbons

Question 1

These hydrocarbons are associated with the most severe systemic toxicity

Answer 1

aromatic and halogenated hydrocarbons

Question 2

These are associated with the highest aspiration risk

Answer 2

Volatile agents

Question 3

T or F

Serious toxicity and deaths associated with hydrocarbon exposure are usually due to inges- tions rather than inhalation.

Answer 3

True

Question 4

Short-chain aliphatic compounds (up to 4 carbons), such as methane, ethane, propane, and butane, are_________

intermediate-chain aliphatic compounds (5 to 19 carbons), such as solvents, lamp oil, lighter fluid, and gasoline, are _______

long-chain aliphatic compounds (>19 carbons), such as waxes, are ________

Answer 4

Gases

Liquid

Solids

Question 5

The most commonly abused volatile hydrocarbons are

Answer 5

paints, solvents, and gasoline

Question 6

refers to the general “thickness” of a liquid

Answer 6

Viscosity

Question 7

refers to the property where liquid molecules tend to cohere to each other

Answer 7

Surface tension

Question 8

refers to the ability of the liquid or solid to vaporize and is inversely related to the boiling point

Answer 8

Volatility

Question 9

Ingestion of liquids with ____ viscosity and surface tension and ______ volatility increases the risk for aspiration because these substances flow easily, spreading out widely on the oral mucosa, and vaporize at body temperature

Answer 9

low viscosity, low surface tension

high volatility

Question 10

The __________ characteristics contribute the most to aspiration risk

Answer 10

physical

Question 11

True or false

Hydrocarbon aspiration causes chemical pneumonitis by direct toxicity to the pulmonary parenchyma and alteration of surfactant function.

Answer 11

True

Question 12

True or false

The clinical manifestations of pulmonary aspiration are usually apparent soon after exposure from irritation of the oral mucosa and tracheobronchial tree.

Symptoms include coughing, choking, gasping, dyspnea, and burning of the mouth.

Patients with these symptoms should be assumed to have aspirated.

Answer 12

True

Question 13

Hyperthermia of ≥39°C (≥102.2°F) is likely and may occur initially or ______ after exposure.

Answer 13

6 to 8 hours

The fever is usually an inflammatory response due to pneumonitis.

Question 14

True or false

Changes may be seen as early as 30 minutes after aspiration, but the initial radiograph in a symptomatic patient may be deceptively clear.

Answer 14

True

Question 15

Conversely, an asymptomatic patient can still have abnormal chest radiographic findings. Radiographic changes usually appear by ________ ; if they are going to occur, they are almost always present by ________.

Answer 15

2 to 6 hours

24 hours

Question 16

The most common radiologic finding is

Answer 16

bilateral infiltrates at the bases

Question 17

The most worrisome acute complication found in solvent abusers is____________which occurs within minutes of exposure.

Answer 17

“sudden sniffing death syndrome”

Question 18

Mechanism of toxicity in “sudden sniffing death syndrome”

Answer 18

The mechanism of toxicity is believed to be catecholamine sensitization of the heart by hydrocarbons (especially halogenated hydrocarbons), resulting in ventricular dysrhythmias.

Other mechanisms for sudden death include simple asphyxia, respiratory depression, and vagal inhibition.

Question 19

True or false

Avoid administration of catecholamines such as dopamine, norepinephrine, and epinephrine.

Answer 19

True

Catecholamines may cause dysrhythmias, especially after exposure to halogenated hydrocarbons and aromatic hydrocarbons.

Question 20

____________should be considered in individuals (especially young patients) who come to the ED with symptoms similar to hypokalemic ‘ periodic paralysis.

Answer 20

Toluene abuse

Question 21

Why don’t we induce vomiting ?

Answer 21

Vomiting, which occurs in many patients with aliphatic hydrocarbon ingestions, increases the risk of pulmonary aspiration.

Question 22

Naphthalene exposure is associated with which hematology abnormality?

Answer 22

hemolytic anemia

Question 23

For hydrocarbon-induced ventricular dysrhythmias, these antiarrhythmics should be avoided because of the risk of QT interval prolongation.

Answer 23

class IA (procainamide) or class III (amiodarone, bretylium, and sotalol)