Transcript Slide 1
MANAGEMENT OF EXPOSURE TO HYDROGEN FLOURIDE OR HF
PRESENTED BY: Miguel Trevino, M.D.
Occupational Medicine U.de M - U.C.S.C - FACOEM MRO
GENERAL INFORMATION ABOUT HF
USES OF HF ELECTRONICS.-
Production of microchips, electronic circuit cleaners.
METALURGY
. Metal pickling/Aluminum manufacture
PETRO CHEMICALS.-
As a catalyst in the alkalization of gasoline.
GLASS INDUSTRY
. Glass edging .
REFRIGERENT GASES.-
For automotive, air conditioning, refrigerator home/industry .
FIRE EXTINGUISHERS.-
Fluorocarbons.
USES OF HF FLUOROCHEMICALS
. Fluorinated Salts Production.
ANTIADHERENTS.-
Production of Teflon.
MEDICINE
. Propellants for medication, anesthetic gases, antibiotic production, production and finishes of surgical prosthesis.
NUCLEAR INDUSTRY.-
Purification of uranium ore.
AGROCHEMICALS.
Pesticides.
CLEANING SOLUTIONS.
Rust removers.
PHYSICAL CHEMICAL PROPERTIES
FREEZING POINT VAPOR DENSITY 118ºF 3.0 AT -83ºC 25ºC SPECIFIC GRAVITY (2514) 0.97
• • •
VAPOR PRESSURE BOILING POINT VOLATILITY AT 20ºC 775MM Hg 67 ºF 100% SOLUBILITY IN WATER 100% 19ºC ODOR PUNGENT & IRRITATING PHYSICAL STATE GAS DISSOCIATION K=3.5 x 10-4
PHYSIOPATHOLOGY OF EXPOSURES & KNOWN TOXICOLOGY
HF
TISSUE
//////////////////
H + F
-
ENTRY ROUTES
SKIN RESPIRATORY TRACT EYES GASTRO-INTESTINAL
TYPES OF EXPOSURE
LIQUID EXPOSURE (SPLASH BURN).
GAS EXPOSURE (INHALATION, SKIN & EYES).
LIQUID & GAS (MIXED EXPOSURE).
LOW CONCENTRATION HF SOLUTIONS.
Once ionized, the fluoride creates two types of salts:
INSOLUBLE SALTS
F ˉ + Ca (++ ) = Ca F (2) Fˉ + Mg (++ ) = Mg F
Calcium Fluoride
Magnesium Fluoride This can lead to Hypoglycemia that in turn can lead to Cardio Respiratory Arrest, Hypomagnesaemia, Na (Sodium) and K (Potassium) alterations.
SOLUBLE SALTS
F ˉ + Na (+) = Na F Fˉ + K (+) = KF Sodium Fluoride Potassium Fluoride Which target: The Kidneys – Nefro - Toxic The Liver – Liver - Toxic And are the cause of Acute Fluoride Intoxication if sufficient quantities are created.
SO, WHY IS HF A HAZARDOUS MATERIAL?
It is a Corrosive. (Acid)
It is a Poison. (Toxic)
It is an Inhalation Hazard.
INTRINSIC PROCESS RISK FACTORS IN RELATION TO HF
CHEMICAL FACTORS PHOSGENE CYLINDERS 200 HCN RAILROAD TANK 10 H2S C12 SO2 AHC1 AHF PRESSURIZED TANK RAILROAD TANK IN CYLINDER ROAD TANK IN A RAILROAD TANKER 10 9 8 2.5
1 Br2 SO3 NH3 OLEU NH3 MMA Br2 POC13 PRESSURIZED TANK PRESSURIZED TANK 0.80
0.60
0.30
NORMAL ATM CONDITIONS PRESSURIZED TANK AT 33 ºC 0.20
0.09
TANK NORMAL ATM CONDITIONS 0.05
0.05
PRESSURIZED TANK 0.04
RISK FACTORS IN RELATION TO HF WHEN HF = 1.0
Acute
KNOWN TOXICOLOGY
Corrosive Effects (Burns) Acute Fluoride Intoxication
Sub-Acute
Impaired Breathing (hours after) Delayed appearance of skin injury (hours after)
Chronic or Long Term
Injury to tissue due to corrosive and toxic effects. No other effects documented or reported. Possible Fluorosis after chronic exposure to low concentrations of HF.
KNOWN TOXICOLOGY
Reproductive & Developmental None described or found Immuno-Toxicity None described or found Cancer Forming No human reports or studies Cardiac & Muscular Toxicity Yes, due to Fluoride binding to Calcium, and Magnesium.
KNOWN TOXICOLOGY Hepatic & Nefro Toxicity
Yes, due to creation of Sodium Fluoride and Potassium Fluoride after exposure (untreated).
KNOWN TOXICOLOGY
TWA
Time weighted average concentration for a normal 8 hour workday and a 40 hour work week to which nearly all workers may be repeatedly exposed, day after day, without adverse effects for all of their working life 3PPM (ACGIH).
KNOWN TOXICOLOGY
IDLH = 30 ppm
Immediately dangerous to life and health (NIOSH).
KNOWN TOXICOLOGY
ERPG 1 = 5 ppm
The maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without experiencing other than mild, transient adverse health effects or without perceiving a clearly defined objectionable odor.
KNOWN TOXICOLOGY
ERPG 2 = 20 ppm
The maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without experiencing or developing irreversible or other serious health effects or symptoms which could impair an individual’s ability to take protective action .
KNOWN TOXICOLOGY
ERPG 3 = 50 ppm
The maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to an hour without experiencing or developing life threatening health effects.
PRIMARY DECONTAMINATION PROCEDURES
DECONTAMINATION PROCEDURES
GO TO THE NEAREST FUNCTIONAL DECON UNIT.
OPEN THE WATER VALVE.
TAKE OFF ALL CLOTHING, SHOES & JEWELRY.
REMOVE GOGGLES LAST, FACE THE WATER FLOW, CLOSE YOUR EYES, PULL GOGGLES OVER YOUR HEAD.
REMEMBER, MAXIMUM TIME UNDER SHOWER IS 5 MINUTES.
This is a Dilution Technique.
TRIAGE
PRIMARY TRIAGE
1 ST To Go Many Signs & Symptoms of Exposure 2 nd To Go Signs and Symptoms Present and Possible Systematic Effects in Near Future 3rd To Go Minor or No Signs & Symptoms Do Not Go Fatalities
SUGGESTED TREATMENT THROUGH HISTORY
WASH COPIOUSLY WITH WATER FOR 15 MINUTES.
SODIUM BICARBONATE SOLUTIONS MAGNESIUM SULFATE PASTE.
MAGNESIUM OXIDE PASTE.
AMMONIA SOLUTIONS & INHALANT.
HYAMINE SOLUTIONS 0.2% (2 gm BENZEHTONIUM CHLORIDE IN 1 LITER OF ICE WATER).
SUGGESTED TREATMENT THROUGH HISTORY
ZEPHIRAN 0.13% (1.3 gm BENZALKONIUM CHLORIDE IN 1 LITER OF ICE WATER).
CALCIUM GLUCONATE SOLUTIONS: 10%, 5%, 2.5%, 1% CALCIUM GLUCONATE GEL 2.5%.
CALCIUM ACETATE SOLUTIONS.
ORAL CALCIUM & MAGNESIUM BASED ANTACIDS AND SOLUTIONS
.
SUGGESTED TREATMENT THROUGH HISTORY
INTR-ARTERIAL CALCIUM TECHNIQUE (BOLUS AND SLOW INFUSION).
INTRA-VENOUS CALCIUM TECHNIQUE (BIEAR BLOCK).
HEXAFLUORINE RINSING SOLUTION.
DMSO + CALCIUM GLUCONATE SOLUTION
.
FIRST AID PROCEDURES
FIRST AID SKIN EXPOSURE
MINOR BURNS
Burns smaller than 2 square inches of body surface, such as small droplets, or very small skin burns, low concentration gas or solution exposures.
MAJOR BURNS
Burns larger than 2 square inches with A.H.F.
AFTER DECONTAMINATION Initiate calcium gluconate 2.5% gel inunction. Note the time you start this step.
Obtain medical attention (call).
If pain does not subside in 20-30 minutes, go to medical treatment.
FIRST AID: EYES
ALL EXPOSURES ARE CONSIDERED SEVERE.
DECON: USE EYEWASH, A GLASS OR LOW PRESSURE WATER HOSE. MAXIMUM TIME IS 5 MINUTES.
IRRIGATE: 500cc to 1000cc OF A 1% CALCIUM GLUCONATE SOLUTION IN NORMAL SALINE PER EYE.
FIRST AID: EYES
SEEK SPECIALIZED MEDICAL ATTENTION IMMEDIATELY. USE CALCIUM GLUCONATE AT 1% CONCENTRATION UNTIL MEDICAL HELP IS REACHED.
IF THERE IS SKIN EXPOSURE, ALSO FOLLOW SKIN DECONTAMINATION AND FIRST-AID PROCEDURES.
FIRST AID INHALATION
DECON
ADMINISTER OXYGEN AT 12 LTS. PER MINUTE.
START NEBULIZING A 2.5% SOLUTION OF CALCIUM GLUCONATE IN NORMAL SALINE, USING A STANDARD NEBULIZER OR ULTRA NEBULIZER. PREFERABLY NOSE AND MOUTH MASK AND ¾ IN. TUBING
OBTAIN MEDICAL ASSISTANCE.
FIRST AID: INGESTION
CONCIOUS PATIENT: GIVE ORALLY HIGH AMOUNTS OF ANY CALCIUM OR MAGNESIUM BASED ANTACID, EFFERVESCENT CALCIUM IN WATER, MILK OR WATER
.
DO NOT INDUCE VOMITING!
UNCONCIOUS PATIENT: OBTAIN MEDICAL ASSISTANCE IMMEDIATELY.
DO NOT FORGET TO DECONTAMINATE SKIN OR EYES IF THEY WERE EXPOSED.
SECONDARY DECONTAMINATION PROCEDURES
SECONDARY DECONTAMINATION
EXAMINE & DECONTAMINATE: -EAR CANALS -MOUTH -NOSE -ANUS -VAGINA
EXAMINE & DECONTAMINATE SKIN FOLDS: -NECK
SECONDARY DECONTAMINATION
-
AXILARY REGIONS -SUB-MAMMARIAN FOLDS -GROIN -BEHIND THE KNEES -INTER-DIGITAL FOLDS
EXAMINE & DECONTAMINATE BELOW THE NAILS OF: -HANDS -FEET
SECONDARY DECONTAMINATION
EXAMINE & DECONTAMINATE AREAS COVERED WITH HAIR: -SCALP -PUBIS -OTHER AREAS AS NEEDED
ELECTROCARDIOGRAPHIC EFFECTS
PROLONGED Q-T INTERVAL (DUE TO HYPOCALCEMIA).
NORMAL SERUM CALCIUM LEVELS: 2.25 TO 2.6 mmol/lt 9 TO 10.5 mg/dl
MEDICAL TREATMENT PROCEDURES
FLUORIDE IN SERUM OR IN URINE
CLINICALLY - THE BEST INDICATOR IS URINE FLUORIDES. EASY TO DO, RESULTS IN MINUTES AND DEPENDABLE . FLUORIDES IN SERUM ARE NOT RELIABLE INDICATORS BECAUSE IT DOES NOT PROVIDE A GOOD MEASURE OF EXPOSURE TO FLUORIDES, AND IS COMPLICATED TO PERFORM, MAY TAKE DAYS BEFORE REPORTED.
LONG TERM EFFECTS
FIRST
:
SEQUELA NORMALLY ARE ESTABLISHED IN THE SUB-ACUTE TIME PERIOD AFTER EXPOSURE AND ARE NORMALLY STABLE, SUCH AS:
*
SKIN HYPO-PIGMENTATION * KELOID SCARING * DEEP SEATED SCARING * SURGICAL SCARS * NEUROLOGIC, LIVER AND KIDNEY DISFUNCTION MAY PERSIST IF DAMAGE IS SEVERE.
LONG TERM EFFECTS
SECOND
THE FOLLOWING HAVE NOT BEEN OBSERVED: *
HYPER-REACTIVE AIRWAYS
*
KIDNEY, LIVER OR CNS DYSFUNCTION
*
CANCER
*
REPRODUCTIVE PROBLEMS, ETC (SEE TOXICOLOGY)
CALCIUM GLUCONATE AS THE TREATMENT OF CHOICE
WHY ?
*
EASY TO USE.
* CAN BE USED IN FIRST AID & MEDICAL TREATMENT.
* CAN BE USED TOPICALLY, INFILTRATED, INHALED, OPTHAMICALLY AND INTRAVENOUSLY.
* NO SOPHISTICATED MEDICAL EQUIPMENT REQUIRED, SUCH AS ARTERIAL CATHETERS, IV INFUSERS, ETC.
* EASY TO PREPARE IN GEL FORM OR SOLUTIONS.
* TREATMENT IS FAST AND EFFECTIVE.
* THE RESULTING REACTION CHEMICAL IS PRIMARILY GLUCOSE AS COMPARED TO AMMONIUM FLUORIDE & ACETIC ACID, IN THE CASE OD AMMONIA COMPOUNDS OR CALCIUM ACETATE, RESPECTIVELY.
*
CALCIUM IS MUCH MORE FAVORED TO BIND WITH FLUORIDE IN THE BODY.
* NONE OR MINOR TISSUE IRRITATION AT DESCRIBED CONCENTRATIONS.
* EXCELLENT RESULTS IN BOTH HIGH & LOW CONCENTRATION EXPOSURES OF HF.
* NO SECONDARY EFFECTS AT THERAPEUTIC LEVELS.
* NO NEED FOR SOAKING OR COOLING WITH RESULTING HYPOTHERMIC OR VASCULAR RISKS.
* IT IS AN EXCELLENT OUTSIDE SOURCE OF CALCIUM THAT WILL BIND THE FLUORIDE, AND IN DOING SO, WILL HELP AVOID HYPOCALCEMIA, AND THE CREATION OF TOXIC COMPOUND IN THE BODY.
* CAN BE USED IN THE PRODUCTION FIELD, IN TRANSPORTATION INCIDENTS AND IN HOSPITALS.
ALGORITHMS FOR EMERGENCY MEDICAL PROCEDURES FOR HYDROFLUORIC ACID EXPOSURE
HF Exposure Decontamination = DECON = Procedures Recognize Exposure Rout (s) Skin - Eyes - Inhalation - Ingestion Evaluate the severity of the Exposure
Pain Subsides
Minor
First aid Protocols Pain Continues
Go to
Major
Systemic Effects
Medical Treatment Protocols
and
Systemic Effects Treatment Protocols
Skin Exposure Decontamination Procedure. Decontamination Procedures for HF Containing Oils & Tars.
•Go to the nearest water source or safety shower.
Where the possibility of Exposure Exists.- and wearing acid resistant gloves.
•Open the valve.
•Remove all clothing, shoes, and jewerly.
•Remove eye protection last while facing the water flow. •Remember no more than
five (5) minutes
under the water flow. A) Remove the oil of Tor with baby-oil and Mechanical Means such as gauze,or tung depressors consider the materials used as a Hazardous waste and handle them adequately.
B) Remove baby-oil residue thoroughly by washing with soap and water.
C) Follow basic decontamination procedure.
Minor Exposure
Major
Exposure Signs & Symptoms.
•Low concentration of HF<30% •< 3 sg.in. Of exposed skin. To AHF.
•Injury appears hours after exposure.
•Superficial injury.
•Conscious and Stable Signs & Symptoms.
•AHF or high concentration >30% •> 3 sg.in of exposed skin to AHF.
•Injury appears immediately after exposure.
•Deep or extensive injury.
•Unconscious - or unstable.
•Face, Neck, Groin, genital exposure.
•Cardiac Arrithmia. (Irregular heart beats).
First-Aid Procedures.
•Rub-in calcium-gluconate 2.5% gel for 20 to 30 minutes.
•Pain significantly decreases or subsides. Stop & observe.
•
Never
use local anesthetics.
First-Aid Procedures.
•Rub-in calcium-gluconate 2.5% gel for 20 to 30 minutes.
•Pain
does not
decrease or subsides - within the first 20 to 30 Minutes.
Medical Treatment Procedures. = Injury Treatment = •Inject into, around and under all injuries a solution of a 2.5% calcium gluconate solution in normal saline.
= Systemic Toxicity Treatment = •Start IV drip of 1000 cc in normal saline +20 cc of 10% calcium gluconate.
•The amount of solution administered will depend on the levels of Serum calcium (titer).
•Monitor ECG, Electrolytes with special interest on Ca, Mg, Na and K, Chest “x” Rays, Blood gases, Ph, Blood Chemistry, fluoride in urine and blood, liver & kidney function.
•Consider.- Intra Arterial slow infusion, of calcium gluconate and •Consider Hemodialisis for the removal of serum Fluorides.
Skin Exposure Decontamination Procedure.
Decontamination Procedures for HF Containing Oils & Tars.
•Go to the nearest water source or safety shower.
Where the possibility of Exposure Exists.- and wearing acid •Open the valve.
water flow. resistant gloves.
A) Remove the oil of Tar with baby-oil and Mechanical Means such as gauze, or tongue depressors (consider the •Remove all clothing, shoes, and jewelry. •Remove eye protection last while facing the water flow. •Remember no more than
five (5) minutes
under the Material used as a Hazardous waste and handle them adequately).
B) Remove baby-oil residue thoroughly by washing with soap and water.
C) Follow basic decontamination procedure.
Minor Exposure
Major
Exposure Signs & Symptoms.
•Low concentration of HF<30% •< 3 sg.in. Of exposed skin. To AHF.
•Injury appears hours after exposure.
•Superficial injury.
•Conscious and Stable Signs & Symptoms.
•AHF or high concentration >30% •> 3 sg.in of exposed skin to AHF.
•Injury appears immediately after exposure.
•Deep or extensive injury.
•Unconscious - or unstable.
•Face, Neck, Groin, genital exposure.
•Cardiac Arrithmia.
(Irregular heartbeats).
First-Aid Procedures.
•Rub-in calcium-gluconate 2.5% gel for 20 to 30 minutes.
•Pain significantly decreases or subsides. Stop & observe.
•
Never
use local anesthetics.
First-Aid Procedures.
•Rub-in calcium-gluconate 2.5% gel for 20 to 30 minutes.
•Pain
does not
decrease or subsides - within the first 20 to 30 Minutes.
Medical Treatment Procedures. = Injury Treatment = •Inject into, around and under all injuries a solution of a 2.5% calcium gluconate solution in normal saline.
= Systemic Toxicity Treatment = •Start IV drip of 1000 cc in normal saline +20 cc of 10% calcium gluconate.
•The amount of solution administered will depend on the levels of Serum calcium (titer).
•Monitor ECG, Electrolytes with special interest on Ca, Mg, Na and K, Chest “x” Rays, Blood gases, Ph, Blood Chemistry, fluoride in urine and blood, liver & kidney function.
•Consider.- Intra Arterial slow infusion, of calcium gluconate and •Consider Hemodialisis for the removal of serum Fluorides.
Respiratory Exposure Decontamination Procedures.
•
Not Possible =
•
If gaseous exposure occurs skin and eye decontamination is necessary.
Minor Exposure Signs & Symptoms.
•No signs & symptoms.
•Minor coughing.
•Minor swelling and Eritlema.
First-Aid Procedures.
•Administer O2 at a rate of 12 Lts./min.
•Nebulize calcium gluconate 2.5% in normal saline for 15 to 20 min.
•Obtain Medical Evaluation and observe.
Major
Exposure Signs & Symptoms.
•Coughing •Labored Breathing.
•Shortness of Breath •Erithema •Swelling •Bleeding •Upper Airway Edema.
•Pulmonary Edema.
•Cardiac Arrithmia. (Irregular heart beats).
First-Aid Procedures.
•Administer O2 at a rate of 12 lts./min.
•Continuously nebulize calcium gluconate 2.5% in normal saline until medically evaluated.
•If respiratory assistance is needed use indirect methods - (Bag-micro shield). Medical Treatment Procedures. =Respiratory Track = & Systemic Toxicity.
•Air Way & Breathing must be secured. Evaluate ABC; and follow ACLS procedures.
•Positive Pressure Assistance and Positive end expiratory pressure (peep). Are necessary.- until edema has resolved.
•Evaluate and monitor.- Chest “x” Rays, Blood Gases, ECG, Electrolytes with special interest in Ca, Mg, Na, and K, Blood Chemistry, fluorides in urine and blood, liver & Kidney functions.
•Start IV drip of 1000 cc in normal seline. +20 cc of 10% Calcium Gluconate.
•The amount of the solution will depend on the levels of serum calcium.
•Consider Hemodialisis for the removal of serum Fluorides.-
Respiratory Exposure Decontamination Procedures.
•
Not Possible
•
If gaseous exposure occurs skin and eye decontamination is necessary.
Minor Exposure
Signs & Symptoms.
•
No signs & symptoms.
•
Minor coughing.
•
Minor swelling and Eritlema.
Major
Exposure
Signs & Symptoms.
•
Coughing
•
Labored Breathing.
•
Shortness of Breath
•
Erithema
•
Swelling
•
Bleeding
•
Upper Airway Edema.
•
Pulmonary Edema.
•
Cardiac Arrithmia. (Irregular heart beats).
First-Aid Procedures.
•
Administer O2 at a rate of 12 Lts./min.
•
Nebulize calcium gluconate 2.5% in normal saline for 15 to 20 min.
•
Obtain Medical Evaluation and observe.
First-Aid Procedures.
•
Administer O2 at a rate of 12 lts./min.
•
Continuously nebulize calcium gluconate 2.5% in normal saline until medically evaluated.
•
If respiratory assistance is needed - use indirect methods (Bag-microshield).
Medical Treatment Procedures. =Respiratory Track = & Systemic Toxicity.
•
Air Way & Breathing must be secured. Evaluate ABC; and follow ACLS and ATLS procedures.
•
Positive Pressure Assistance and Positive end expiratory pressure (peep). Are necessary.- until edema has resolved.
•
Evaluate and monitor. Chest “x” Rays, Blood Gases, ECG, Electrolytes with special interest in Ca, Mg, Na, and K, Blood Chemistry, fluorides in urine and blood, liver & Kidney functions.
•
Start IV drip of 1000 cc in normal seline. +20 cc of 10% Calcium Gluconate.
•
The amount of the solution will depend on the levels of serum calcium.
•
Consider Hemodialisis for the removal of serum Fluorides.-
Eye Exposure
Minor Exposure Signs & Symptoms.
•Irritation of conjunctiva layer and eye lid skin (minor).
•Conjuctival injection.
•No evidence of corneal injury.
•No vision loss
Decontamination Procedure.
•
Go to the nearest water source or eye wash.
•
Open the valve.
•
Mechanically maintain eye lids open, or ask for help.
•
Wash for five minutes (5) and no more.
Major
Exposure Signs & Symptoms.
•Severe irritation of the conjunctival eye, and skin burn to eye lids. •Conjuctival injection and swelling.
•Corneal “Opacification” or Pitting.
•Vision loss.
First-Aid Procedures.
•Irrigate eyes with a 1% Calcium gluconate solution in normal saline 1000 cc per eye (15 min. aprox.).
•The use of an irrigating system (Morgan Lens) after using a local eye anesthetic (one or two drops per eye) should be considered.
•Obtain specialized medical evaluation.
First-Aid Procedures.
•Irrigate eyes with a 1% calcium gluconate solution in normal saline 1000 cc per eye (15 min. Aprox.). •The use of an irrigating system (Morgan Lens) after using a local eye anesthetic (one or two drops per eye) should be considered.
•Specialized Medical Evaluation should be done (Slit lamp, etc).
Medical Treatment Procedures. •If necessary continue treatment with a 1% solution of calcium gluconate in normal saline. •Antibiotics and steroids can be used as indicated by eye specialist.
•Monitor ocular pressure.
•Evaluate corneal opacification regularly. •If skin, ingestion or inhalation exposure occurs do not forget to decontaminate, and follow systemic toxicity treatment protocols.
•Psychological support may be necessary.
Eye Exposure Decontamination Procedure.
•
Go to the nearest water source or eye wash.
•
Open the valve.
•
Mechanically maintain eye lids open, or ask for help.
•
Wash for five minutes (5) and no more.
Minor Exposure
Major
Exposure
Signs & Symptoms.
•
Irritation of conjunctiva layer and eye lid skin (minor).
•
Conjuctival injection.
•
No evidence of corneal injury.
•
No vision loss.
Signs & Symptoms.
•
Severe irritation of the conjunctival eye, and skin burn to eye lids.-
•
Conjuctival injection and swelling.
•
Corneal “Opacification” or Pitting.
•
Vision loss.
First-Aid Procedures.
•
Irrigate eyes with a 1% Calcium gluconate solution in normal saline 1000 cc per eye (15 min. aprox.).
•
The use of an irrigating system (Morgan Lens) after using a local eye anesthetic (one or two drops per eye) should be considered.
•
Obtain specialized medical evaluation.
First-Aid Procedures.
•
Irrigate eyes with a 1% calcium gluconate solution in normal saline 1000 cc per eye (15 min. Aprox.).-
•
The use of an irrigating system (Morgan Lens) after using a local eye anesthetic (one or two drops per eye) should be considered.
•
Specialized Medical Evaluation should be done (Slit lamp, etc).
Medical Treatment Procedures.-
•
If necessary continue treatment with a 1% solution of calcium gluconate in normal saline.-
•
Antibiotics and steroids can be used as indicated by eye specialist.
•
Monitor ocular pressure.
•
Evaluate corneal opacification regularly.-
•
If skin, ingestion or inhalation exposure occurs do not forget to decontaminate, and follow systemic toxicity treatment protocols.
•
Psychological support may be necessary.
Ingestion Decontamination Procedures.
•
Not Possible
•
If skin or eyes have been exposed decontamination procedures should be followed.
Minor Exposure ALL EXPOSURES ARE CONSIDERED
MAJOR.
Major
Exposure Signs & Symptoms.
•Erithema of oral mucousa.
•Oral injury.
•Bleeding of the oral cavity.
•Systemic Toxicity.
•Possible bronchial or pulmonary problems if the patient vomited.
First-Aid Procedures.
•
Do Not induce Vomiting.
•If patient is able to swallow give oral calcium solutions - or - calcium based antacids - milk or water.
•If unconscious obtain Medical Attention Immediately Medical Treatment Procedures. •HF destroys fiber optics - consider before using endoscopic techniques.
•Establish IV drip 1000 cc Normal Saline + 20cc - 10% calcium gluconate.
•If possible install a naso-gastric or oral-gastric tube.
•Gastric Lavage with calcium solutions, calcium or magnesium based antacids.
Systemic Toxicity Control.
•The amount of calcium or magnesium to be administed will depend on the serum levels.
•Monitor ECG, Electrolytes, with special interest on Ca, Mg, K, and Na, Chest X Rays may be necessary, blood gases, blood Chemistry, Kidney and Liver functions.
•Follow ACLS ATLS procedures.
•Consider Hemodialisis for the removal of fluorides in Blood.
Ingestion Decontamination Procedures.
•
Not Possible
•
If skin or eyes have been exposed decontamination procedures should be followed.
Minor Exposure
ALL EXPOSURES ARE CONSIDERED MAJOR.
Major
Exposure
Signs & Symptoms.
•
Erithema of oral mucousa.
•
Oral injury.
•
Bleeding of the oral cavity.
•
Systemic Toxicity.
•
Possible bronchial or pulmonary problems if the patient vomited.
First-Aid Procedures.
•
Do Not induce Vomiting.
•
If patient is able to swallow give oral calcium solutions - or - calcium based antacids - milk or water.
•
If unconscious obtain Medical Attention Immediately Medical Treatment Procedures.-
•
HF destroys fiber optics - consider before using endoscopic techniques.
•
Establish IV drip 1000 cc Normal Saline + 20cc - 10% calcium gluconate.
•
If possible install a naso-gastric or oral-gastric tube.
•
Gastric Lavage with calcium solutions, calcium or magnesium based antacids. Systemic Toxicity Control.
•
The amount of calcium or magnesium to be administed will depend on the serum levels.
•
Monitor ECG, Electrolytes, with special interest on Ca, Mg, K, and Na, Chest X Rays may be necessary, blood gases, blood Chemistry, Kidney and Liver functions.
•
Follow ACLS ATLS procedures.
•
Consider Hemodialisis for the removal of fluorides in Blood.
PATIENT’S PROGNOSIS & LONG-TERM EFFECTS WILL DEPEND UPON:
EXPOSURE TIME.
DECONTAMINATION
ROUTE OF ENTRY
CONCENTRATION OF HF.
TYPE OF TREATMENT GIVEN
HOW FAST TREATMENT WAS GIVEN.
GENERAL STATE OF THE PATIENT.
IF THE TREATMENT IS OPPORTUNE AND ADEQUATE, PROGNOSIS WILL BE GOOD IN MOST CASES.
MEDICATION & DRESSING MATERIALS THAT SHOULD EXIST WHEREVER HF IS HANDLED
1. IN THE FIELD
DECONTAMINATION UNITS CONSIST OF
: √
SAFETY SHOWER
√
EYEWASH
√
SEALED BOX WITH
: *
PAIRS OF GLOVES
*
2 TUBES OF HF GEL 30 GRAMS EACH
*
1 ALUMINIZED PLASTIC SHEET
2. IN AN AMBULANCE, MEDICAL AREAS, OR ANY WHERE MEDICALLY TRAINED PROFESSIONALS ARE AVAILABLE
ALUMINIZED PLASTIC SHEETS
HF GEL 2.5%
EYE IRRIGATION SOLUTION 1%
NEBULIZING SOLUTION 2.5%
5 CALCIUM GLUCONATE AMPS
NORMAL SALINE IV SOLUTION
WATER SOLUBLE LUBRICANT GEL
LOCAL OPTHAMALIC ANESTHETIC GLOVES – LATEX, PVC OR NEOPRENE
HYPODERMICS, SEVERAL SIZES & CALIBERS, STAINLESS STEEL NEEDLES
MORGAN LENS
MORGAN LENS DELIVERY SYSTEM (Y)
IV DELIVERY SYSTEMS
COLD PACKS
TRACHEOSTOMY KIT
WELL STOCKED EMERGENCY CART
DEFIB / MONITOR UNIT
INHALATION THERAPY EQUIPMENT
NEBULIZERS
MINOR SURGICAL KIT
CALCIUM EFFERVESCENT TABLETS
DRESSING MATERIALS
3.
HYDROFLUORIC ACID KIT
SHOULD BE IN CONTROL ROOMS OR WELL CONTROLLED AREAS. THEY ARE COMPOSED OF TWO MAIN PARTS: A.
INHALATION THERAPY UNIT O (2) CYLINDER VALVE, FLOWMETER PRESSURE METER NEBULIZER, TUBING & MASK.
B.
ONE PORTABLE CONTAINER THAT CONTAINS: * 4 PAIRSOF GLOVES – LATEX, PVC, NEOPRENE * 1 FLASHLIGHT * 1 LITER OF 1% CALCIUM SOLUTION IN NORMAL SALINE
*1 LITER OF 2.5% CALCIUM SOLUTION IN NORMAL SALINE * 8 TUBES OF HF GEL, 2.5% * 5 AMP OF CALCIUM GLUCONATE, 10% SOL * 5 NEEDLES, 25 CAL 1 ½” LONG, STAINLESS STEEL * 20 STERILE GAUZE * 2 TOURNIQUETS * 2 IV TUBING SETS * 4 BOTTLES OF ANTACID (CALCIUM OR MAGNESIUM BASED)
* 2 IV TUBING SETS * 4 BOTTLES OF ANTACID (CALCIUM OR MAGNESIUM BASED) * 1 BOTTLE OF EFFERVESCENT CALCIUM TABLETS * 1 BOTTLE OF LOCAL EYE ANESTHETIC * 2 COLD PACKS * 2 MAYO CANULAS * 2 ALUMINIZED PLATIC SHEETS * 1 TUBE OF LUBRICATING GEL * 2 STERILE CONTAINERS * 1 IV INFUSOR * 4 MORGAN LENSES
KEYS TO GOOD CONTROL WITH HF
AVOID EXPOSURES THROUGH : * CONTINUOUS EDUCATION.
* GOOD INDUSTRIAL HYGIENE PRACTICES.
* MAXIMUM SAFETY IN HANDLING HF ON & OFF-SITE.
* CONTINOUS MEDICAL TRAINING ON & OFF-SITE.
* PARTICIPATE IN NEIGHBORING COMMUNITY HOSPITALS, EMS, AND OTHER AGENCIES, SO THAT YOU MAY BE PREPARED FOR ANY CONTIGENCY.
SO , PRODUCE, STORE, HANDLE AND DISPOUSE ALL HAZARDOUS CHEMICALS WITH RESPECT AND KNOWLEDGE
FOR YOUR ATTENTION AND PATIENCE THANK YOU VERY MUCH !!!