You. Let s Talk Hazmat. Clues to Hazmat

Transcription

1 Me You Let s Talk Hazmat Clues to Hazmat Location and Occupancy Container Shapes and Sizes Placards and Labels Markings and Colors Shipping Papers Senses CDC NIOSH Guide 1

2 The purpose of chemical protective clothing and equipment is to shield or isolate individuals from the chemical, physical, and biological hazards that may be encountered during hazardous materials operations. During chemical operations, it is not always apparent when exposure occurs. Many chemicals pose invisible hazards and offer no warning properties. Source: OSHA Source: OSHA 2

3 Scenario You are dispatched to a male not feeling well at a local financial institution s headquarters. Enroute, the dispatcher advises you that they have received three additional calls for patients with similar complaints. NH3 = ammonia HCl = hydrochloric acid NaOCl = sodium hypochlorite (bleach) Cl = chlorine Cl2 = chlorine gas NH2Cl = chloramine N2H4 = hydrazine Operating Zones Control Zones Hot: Incident. Essential personnel Warm (limited access): Necessary personnel Cold (Support): Command, Staging, EMS Public/Media have no access to any zone 3

4 Toxidromes a syndrome caused by a dangerous level of toxins in the body Irritant Gas Asphyxiant Cholinergic Corrosive Hydrocarbon & Halogenated Hydrocarbon Irritant Gas Highly Water Soluble Ammonia, Formaldehyde, Hydrogen Chloride Corrosive solution affects upper airway Moderately Water Soluble Chlorine Corrosive solution affects upper & lower airway Slightly Water Soluble Phosgene, Nitrogen Dioxide Corrosive solution causes delayed pulmonary edema Irritant Gas Ammonia causes liquefactive necrosis Hydrogen Chloride in water forms hydrochloric acid. Result is coagulative necrosis Irritant Gas Phosgene mixed with water produces hydrochloric acid Conjunctivitis Rhinitis Pharyngitis Stridor Dysphonia Laryngospasm Aphonia Atelectasis Irritant Gas Tachypnea, dyspnea Hypoxemia: cardiac ischemia, AMI Hypoxemia: anxiety, confusion, seizure, coma Diaphoresis, cyanosis, rhinorrhea, lacrimation Reflex nausea & vomiting Inhalation Symptoms Bluish color to lips and fingernails Chest tightness Choking Coughing Coughing up blood Dizziness Low blood pressure Rapid pulse Shortness of breath Weakness Carbon Dioxide Methane Propane Asphyxiant Simple Displace oxygen from atmosphere Asphyxiant Systemic Isobutyl Nitrite Carbon Monoxide Hydrogen Cyanide Hydrogen Sulfide Hydrogen Azide Interfere with oxygen transport & utilization 4

5 Asphyxiants Interfere with aerobic metabolism Systemic asphyxiants interfere with oxygen transportation at cellular level Inhalation Absorption Ingestion Asphyxiants Carbon Dioxide Fix the hypoxemia Carbon Monoxide Binds to oxygen, causing remaining oxygen to bind more tightly. Not released to tissues. Oxygen. Hyperbaric Chamber. *New onset a fib or a flutter Asphyxiants Cyanides Toxic twins Sulfides Sewer gas Irritant gas Inhibits aerobic metabolism Azides Inhibit aerobic metabolism vasodilator Cholinergic Organophosphate Pesticides Carbamate Insecticides Organophosphate nerve agents Inhalation & Absorption Cholinergic Toxidrome SLUDGEM vs MTWHF For the Paramedics Bind to acetylcholinesterase causing accumulation of acetylcholine Affects muscarinic and nicotinic receptors Muscarinic: SLUDGEM Nicotinic: MTWHF Muscarinic Nicotinic Salivation Mydriasis Lacrimation Tachycardia Urination Weakness Defecation Hypertension Gastroenteritis Fasiculations Emesis Muscle Tremors/Miosis CNS Anxiety Crying/Laughing Restlessness Confusion Ataxia Tremors Seizures Coma ECG findings prolonged QT interval elevated ST segments inverted T waves Sinus tachycardia is the most common finding Sinus bradycardia & PR prolongation with increasing toxicity (excessive parasympathetic activation) 5

6 Treatment Corrosives Remove all clothing Decontaminate Airway management Pulse oximeter Capnography Medicate DuoDote Pralidoxime Chloride 600mg Atropine Sulfate 2.1mg Diazepam Acids Hydrochloric acid Nitric acid Sulfuric acid Bases Ammonium hydroxide Sodium hydroxide Potassium hydroxide Corrosives Any chemical that produces chemical burns Acid: Litmus red, sour taste Base: Litmus blue, bitter taste Corrosives Acids cause coagulative necrosis Tissue death. Limited depth. Base s cause liquefactive necrosis Liquefies and destroys tissue. Corrosives Treatment Secure Airway Laryngospasm, bronchospasm, edema Treat hypovolemia Third spacing Hydrogen Flouride (HF) & White Phosphorous (WP) IV Calcium for cardiac dysrhythmias Morphine for pain Hydrocarbons & Halogenated Hydrocarbons Propane Gasoline Toluene Chloroform Respiratory compromise Huffing What is in welding fume? Metals Aluminum, Antimony, Arsenic, Beryllium, Cadmium, Chromium, Cobalt, Copper, Iron, Lead, Manganese, Molybdenum, Nickel, Silver, Tin, Titanium, Vanadium, Zinc. Gases Shielding Argon, Helium, Nitrogen, Carbon Dioxide. Process Nitric Oxide, Nitrogen Dioxide, Carbon Monoxide, Ozone, Phosgene, Hydrogen Fluoride, Carbon Dioxide Heavy Metal Arsenic Used medicinally to treat certain types of luekemias Often seen in homeopathic remedies and Chinese medicines All forms toxic by ingestion Absorbed through skin Toxic by inhalation 6

7 Arsenic Severe vomiting, Abdominal pain, diarrhea within 3 to 30 minutes if ingested Vasodilation, hypotension, cardiac arrhythmias Antidotes Oxygen Hypoxemia Tissue Hypoxia Asphyxiant Poisoning Methemoglobinemia CO poison Cyanide poison Azide & Hydrozoic acid poison Hydrogen sulfide & Sulfide poisoning Antidotes Hyperbaric Oxygen CO > 25% non pregnant, > 15% pregnant Cyanide poisoning Antidotes Atropine Organophosphate pesticide poisoning Carbamate pesticide poisoning Nerve Agent poisoning Poison mushrooms 1 2 mg q/5 minutes Antidotes Pralidoxime 2 pam Organophosphate pesticide poisoning Nerve Agent poisoning Tabun, GA Sarin, GB Soman, GD GF VX Antidotes Calcium Gluconate Hydroflouric acid burns Hydrogen Flouride toxicity Hypocalcemia Hypomagnesemia Hyperkalemia Adult 10 30ml IV Ped ml/kg IV amanita muscaria Antidotes Calcium Chloride Antidotes Amyl Nitrite Antidotes Sodium Nitrite Hydrogen Flouride toxicity Hypocalcemia Hypomagnesemia Hyperkalemia Calcium Gluconate 4.6 meq per 10ml Calcium Chloride 13.6 meq per 10ml Cyanide poisoning (replaced with Cyanokit) Sulfide poisoning (questionable) Cyanide poisoning (replaced with Cyanokit) Sulfide poisoning (questionable) Instead use IV fluids and vasopressors to treat hypovolemia Calcium Channel Blocker Overdose IV only Adult 0.5gm 1gm (5 10ml) Ped ml 7

8 Antidotes Sodium Thiosulfate Cyanide poisoning Changes cyanide into thiocyanate. Thiocyanate excreted in urine Antidotes Pyridoxine Hydrazine Poisoning Seizures not responding to benzodiazepines 25mg/kg over 5 minutes Enables brain to regenerate gammaaminobutyric acid (GABA) End Note 8