{"id":5428,"date":"2011-07-14T20:26:28","date_gmt":"2011-07-14T20:26:28","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5428.htm\/"},"modified":"2011-10-01T04:26:37","modified_gmt":"2011-10-01T04:26:37","slug":"chemical-injuries","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/toxicology\/chemical-injuries.htm\/","title":{"rendered":"Chemical Injuries"},"content":{"rendered":"<h3><span class=\"ez-toc-section\" id=\"Epinephrine_in_digit\"><\/span>Epinephrine in digit<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>1.\u00a0 Digital block c lidocaine to cause sympathectomy<\/p>\n<p>2.\u00a0 Phentolamine .5-5 mg infiltrated or .5-2.5 mg block.\u00a0 Can give interarterial in radial<\/p>\n<p>or<\/p>\n<p>3.\u00a0 Terbutaline 1:1 dilution .5 mg\/cc use 1 cc<\/p>\n<p>&nbsp;<\/p>\n<p>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<\/p>\n<p>&nbsp;<\/p>\n<h3><span class=\"ez-toc-section\" id=\"High_Pressure_Injection_Injuries\"><\/span>High Pressure Injection Injuries<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Initial sx can be minimal, maybe mild swelling.\u00a0 Hours later signifigant swelling which can progress to compartment syndrome.<\/p>\n<p>Radiographs<\/p>\n<p>Hand consultation<\/p>\n<p>dT and ABX<\/p>\n<p>Surgical exploration and washout<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Hydrofluoric_Acid\"><\/span>Hydrofluoric Acid<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>(HF)<\/p>\n<p>HF is a gas at standard conditions<\/p>\n<p>If bubbled through water, becomes hydrofluoric acid<\/p>\n<p>Used in glass etching, masonry cleaning, rust removal (Naval jelly)<\/p>\n<p>Weak acid, pathology not from acid burn<\/p>\n<p>The F+ binds to Ca and Mg. Hypocalcemia results in cell death and altered membrane potential leading to severe neuropathic pain.<\/p>\n<p>&nbsp;<\/p>\n<p>Get ekg and serum Ca and Mg to check for systemic toxicity<\/p>\n<p>Irrigate for up to 30 minutes<\/p>\n<p>if skin is red or blanched more than topical therapy will probably be needed.<\/p>\n<p>&nbsp;<\/p>\n<p>In concentrations less than 50%, pain can be delayed for hours<\/p>\n<p>Intense pain with paucity of physical findings is the hallmark<\/p>\n<p>&nbsp;<\/p>\n<p>If only skin, try topical calcium gel (add 3.5 gm CaGluc powder or solution with 5 oz. (150 cc) KY Jelly or surgilube<\/p>\n<p>Cover the area with the gel (can use gloves for hands) and reapply in one hour then apply Q4 hours.<\/p>\n<p>If the pain persists &gt;45 minutes after the application of the gel, try more aggressive measures.<\/p>\n<p>&nbsp;<\/p>\n<p>Do not use local anesthetics, you need to know if the patient is still in pain<\/p>\n<p>Use 5% CaGluc (Dilute 1:1 with NS) and inject .5 cc per centimeter square of skin SC<\/p>\n<p>Infiltrate with a 5mm margin<\/p>\n<p>&nbsp;<\/p>\n<p>Bier Block 10-15 cc 10% CaGluc diluted with 30-40 cc NS<\/p>\n<p>&nbsp;<\/p>\n<p>Inhalation:\u00a0 1.5 cc 10% CaGluc to 4.5 cc NS via neb<\/p>\n<p>Eye:\u00a0 50 cc 10% CaGluc in 500 cc NS used as an eye wash<\/p>\n<p>&nbsp;<\/p>\n<p>If still in pain, use interarterial calcium.\u00a0 CaGluc 1 amp in 50 cc D5W, infuse over 4 hrs.<\/p>\n<p>Place an a-line.\u00a0 If\u00a0 4th or 5th finger effected, it will be necessary to advance the catheter to the brachial artery.\u00a0 Admit to the ICU for continuous pressure wave monitoring.\u00a0 Extravisation of Ca salts can be limb destructive, so must assure good tracing.\u00a0 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.)\u00a0 Stop each hour to flush the catheter with heparinized saline and check tracing.\u00a0 Flush with 10 cc of saline over 15 minutes after infusion is done.\u00a0 Can be repeated if pain returns.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Ocular Exposure: <\/strong>\u00a0irrigate with saline, 1 liter only.\u00a0 More can exacerbate damage.\u00a0 Dilute MgSO4 as eye drops.<\/p>\n<p>Ingestion, give calcium or mag salts<\/p>\n<p>Inhalation nebulized MgSO4 or CaGluc, dilute to 2% before use<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Chemical_Burns\"><\/span>Chemical Burns<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><strong>Irrigation with water<\/strong><\/p>\n<ul>\n<li>Most acids and alkali<\/li>\n<li>Hydrocarbons<\/li>\n<\/ul>\n<p><strong>Topical or injectable calcium or magnesium salts<\/strong><\/p>\n<ul>\n<li>Hydrofluoric acid<\/li>\n<\/ul>\n<p><strong>Cover burn with oil<\/strong><\/p>\n<ul>\n<li>Sodium metal<\/li>\n<li>Lithium metal<\/li>\n<\/ul>\n<p><strong>Special measures<\/strong><\/p>\n<ul>\n<li>Sodium and lithium metals: brush away or excise pieces of metal<\/li>\n<li>Phenol: polyethylene glycol wipe<\/li>\n<li>White phosphorus: copper sulfate irrigation<\/li>\n<li>Alkyl mercury agents: debride and remove blister fluid<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>|\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[10],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - 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