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You are here: Home / 14. Toxicology / Chemical Injuries

Chemical Injuries

July 14, 2011 by CrashMaster

Epinephrine in digit

1.  Digital block c lidocaine to cause sympathectomy

2.  Phentolamine .5-5 mg infiltrated or .5-2.5 mg block.  Can give interarterial in radial

or

3.  Terbutaline 1:1 dilution .5 mg/cc use 1 cc

 

But there is actually no data to support the potential of epi used in anesthetic concentrations to do any damage what-so-ever (Can J Emerg Med 5(4) 245 2003) refutes the dogma

 

High Pressure Injection Injuries

Initial sx can be minimal, maybe mild swelling.  Hours later signifigant swelling which can progress to compartment syndrome.

Radiographs

Hand consultation

dT and ABX

Surgical exploration and washout

Hydrofluoric Acid

(HF)

HF is a gas at standard conditions

If bubbled through water, becomes hydrofluoric acid

Used in glass etching, masonry cleaning, rust removal (Naval jelly)

Weak acid, pathology not from acid burn

The F+ binds to Ca and Mg. Hypocalcemia results in cell death and altered membrane potential leading to severe neuropathic pain.

 

Get ekg and serum Ca and Mg to check for systemic toxicity

Irrigate for up to 30 minutes

if skin is red or blanched more than topical therapy will probably be needed.

 

In concentrations less than 50%, pain can be delayed for hours

Intense pain with paucity of physical findings is the hallmark

 

If only skin, try topical calcium gel (add 3.5 gm CaGluc powder or solution with 5 oz. (150 cc) KY Jelly or surgilube

Cover the area with the gel (can use gloves for hands) and reapply in one hour then apply Q4 hours.

If the pain persists >45 minutes after the application of the gel, try more aggressive measures.

 

Do not use local anesthetics, you need to know if the patient is still in pain

Use 5% CaGluc (Dilute 1:1 with NS) and inject .5 cc per centimeter square of skin SC

Infiltrate with a 5mm margin

 

Bier Block 10-15 cc 10% CaGluc diluted with 30-40 cc NS

 

Inhalation:  1.5 cc 10% CaGluc to 4.5 cc NS via neb

Eye:  50 cc 10% CaGluc in 500 cc NS used as an eye wash

 

If still in pain, use interarterial calcium.  CaGluc 1 amp in 50 cc D5W, infuse over 4 hrs.

Place an a-line.  If  4th or 5th finger effected, it will be necessary to advance the catheter to the brachial artery.  Admit to the ICU for continuous pressure wave monitoring.  Extravisation of Ca salts can be limb destructive, so must assure good tracing.  Infuse 10 cc of 10% CaCL dilute c 40 cc NS over 4 hours (Adding 500 units of heparin will signifigantly cut down on catheter clots.)  Stop each hour to flush the catheter with heparinized saline and check tracing.  Flush with 10 cc of saline over 15 minutes after infusion is done.  Can be repeated if pain returns.

 

Ocular Exposure:  irrigate with saline, 1 liter only.  More can exacerbate damage.  Dilute MgSO4 as eye drops.

Ingestion, give calcium or mag salts

Inhalation nebulized MgSO4 or CaGluc, dilute to 2% before use

Chemical Burns

Irrigation with water

  • Most acids and alkali
  • Hydrocarbons

Topical or injectable calcium or magnesium salts

  • Hydrofluoric acid

Cover burn with oil

  • Sodium metal
  • Lithium metal

Special measures

  • Sodium and lithium metals: brush away or excise pieces of metal
  • Phenol: polyethylene glycol wipe
  • White phosphorus: copper sulfate irrigation
  • Alkyl mercury agents: debride and remove blister fluid

 

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Filed Under: 14. Toxicology


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