TOXIC GASES Flashcards
What is paramount in the initial approach to any toxic inhalation situation?
Scene Safety
What is mandatory when managing patients with toxic inhalations?
PPE (Self-contained breathing apparatus)
and
Decontamination
Toxic Inhalations:
Once the patient is safely accessible for the IDC, the mainstay of patient treatment is _____________.
Supportive care with:
1) High flow 100% O2
2) BVM ventilation
3) Endotracheal intubation (ETI) as needed
Inhaled agents manifest their toxic effects by what four different mechanisms?
1) Physical particulates
2) Simple asphyxiants
3) Chemical irritants
4) Chemical asphyxiants
What are small, solid particles that are carried by gases or atmospheric air into the body through inhalation (e.g., dust or combustion soot)?
Physical Particulates
What are the signs and symptoms of physical particulate exposure?
1) Excessive Coughing
2) Shortness of Breath
What is the treatment for a patient that has been exposed to physical particulates?
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.
___________ cause injury by merely being present in an environment and displacing the normal levels of atmospheric oxygen.
Simple Asphyxiants
What gases are Simple Asphyxiants?
1) Carbon dioxide (CO2),
2) Nitrogen,
3) Methane,
4) Natural gas
If a patient has burns on their face, and soot around their mouth, what mechanism of inhaled agent were they most likely exposed to?
Physical Particulates
How do Simple Asphyciants effect the body?
Causing hypoxia by pushing normal oxygen out of the lungs
What are the signs and symptoms of exposure to a simple asphyxiant?
Signs of Hypoxia like:
1) Agitation
2) Unconsciousness
3) Cardiac Arrest
Patients may experience a narcotic-like sleepiness as the initial effect of exposure to what type of simple asphyxiant?
CO2 (Carbon Dioxide)
What is the treatment of Simple Asphyxiant exposure?
1) Gain safe access to patient
2) High concentration O2
3) Cardiopulmonary support as indicated
The mainstay of simple asphyxiant management is ____________________________.
Gaining safe access to patient
__________________express their toxic effects by chemical reaction with the mucus membranes of the eyes and respiratory system
Chemical Irritants
What are the two general classes of chemical irritants?
1) React with water
2) Do not react with water
Chemical irritants that are highly reactive with water are called ____________.
Hydrophilic
What are the two types of Hydrophilic agents?
Hydrochloric acid
Ammonia
What type of agents react quickly with the moist membranes of the eyes and the upper respiratory tree, causing immediate intense burning and pain?
Hydrophilic Chemical Irritant
What is an example of a non- hydrophilic chemical irritant?
Phosgene Gas
What is the treatment of chemical irritant exposure?
1) Supportive care
2) Irrigation of eyes with water or saline
3) Nebulized albuterol treatments if bronchospasm
_____________ cause injury by asphyxiating patients at the cellular level by massively deranging normal cellular utilization of oxygen.
Chemical Asphyxiants
What is the most common example of Chemical Asphyxiants?
Carbon Monoxide (CO)
What product of combustion, rapidly displaces oxygen from the hemoglobin, forming carboxyhemoglobin (COHgb)?
Carbon Monoxide (CO)
What are examples of inhaled chemical asphyxiants?
1) Carbon Monoxide (CO)
2) Cyanide Gas (HCN)
3) Hydrogen Sulfide (H2S)
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?
Carbon Monoxide (CO)
What type of chemical asphyxiant exposure tends to have a very rapid onset and progression of symptoms?
1) Cyanide Gas (HCN)
2) Hydrogen Sulfide (H2S)
What is the treatment for Carbon Monoxide (CO) poisoning?
High-flow oxygen via a non-rebreather mask
or
ET tube for a comatose patient.
What chemical asphyxiant exposure patients are candidates for hyperbaric oxygen therapy?
1) High blood levels of COHgb
2) Pregnant
3) Cardiac Ischemia
4) Loss of conciousness
What chemical has a “Rotten Egg” smell?
Hydrogen Sulfide (H2S)
What is important to remember when treating a patient with Hydrogen Sulfide (H2S) exposure?
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.
What is essential during the transportation of a patient that was exposed to Hydrogen Sulfide (H2S)?
Adequate ventilation of the patient compartment
What advanced therapies should be used for Hydrogen Sulfide (H2S) exposed patients?
1) The Nitrite component of the standard cyanide kit
2) Hyperbaric oxygen therapy
How would a seriously poisoned cyanide victim classically present?
Unresponsiveness,
Hyperventilation
And Hypotension WITHOUT Cyanosis.
What is the treatment for cyanide posioning?
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
What are the drugs (in order) for Cyanide Antidote Therapy?
1) Inhaled amyl nitrite
2) IV sodium nitrite and
3) IV sodium thiosulfate
