Toxic Inhalation

Question 1

Toxic Inhalation - Definition

Answer 1

Inhalation of gases resulting in global tissue hypoxia

Question 2

Goal of Care

Answer 2

Decontamination if required. Airway management and oxygenation. Transport to closest facility that can support pt

Question 3

Overview

Answer 3

The duration of exposure, chemical toxicity, concentration, are the main factors that determine the toxic effects on the patient and their clinical outcome.

The primary areas affected are the airways and respiration. Corrosive toxic effects occur topically from the oral-nasal cavities into the lower airways and down to the alveolar-capillary membrane.

Question 4

Overview - Irritants or Asphyxiants

Answer 4

Many toxic chemicals are water soluble; as such they have an affinity for the body’s areas of moisture

Irritants are classified based on their water solubility : as high, intermediate, and slight

Asphyxiants - are chemicals that interfere with the body’s ability to transport or use oxygen, resulting in asphyxiation
Asphyxiant effects occur within the body at the alveolar and cellular level.

Classified as: simple or systemic

Question 5

Routes of Exposure

Answer 5

• Inhalational

- Dermal (skin and mucous membranes)

Question 6

Asphyxiants

Answer 6

Asphyxiants Toxidrome is also known as “Knockdown Toxidrome” b/c of its ability to have a pt collapse due to a sudden loss of consciousness

Simple Asphyxiants are not as toxic as a chemical but displace oxygen from the ambient air so less oxygen is inhaled.
i.e. Carbon dioxide and Nitrogen are simple asphyxiants

Systemic Asphyxiants are toxic chemicals that interfere w/ the hemoglobin’s oxygen delivery to the tissues or block cellular oxygen metabolism
i.e Carbon monoxide, Cyanide

Question 7

Guiding Principles

Answer 7

Responder safety, is the pt decontaminated?

PPE for Blood, Body, Fluid (BBF) potential

Skin and eye decontamination

Airway management and oxygenation in the prevention of Hypoxemia/Asphyxia

Question 8

Goal of Care/Treatment

Answer 8

CliniCall TA

Decon if required

Airway management and oxygenation

Transfer to closest facility that can support pt. In the lower mainland consider transporting to BCCH unless the pt is unstable

Question 9

Antidotes

Answer 9

O2 therapy - all exposed pts

Hyperbaric chamber - some CO exposure

Hydroxocobalamin - Cyanide poisoning
70mg/kg IV in single infusion; may repeat depending on the severity of poisoning and clinical response

Question 10

Water Soluble Irritant Gasses

Answer 10

High Water SIGs - Ammonia, Hydrochloric Acid

Intermediate WSIGs - Chlorine

Slight WSIGs - Phosgene