Pulmonary chemical agents: Difference between revisions
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==Background== | ==Background== | ||
* | *Include [[ammonia toxicity|ammonia]], [[methyl isocyanate]], [[methyl bromide]], [[hydrochloric acid]] and [[chlorine gas]], [[phosgene]] | ||
*Common toxic industrial chemicals, transported widely across country | *Common toxic industrial chemicals, transported widely across country | ||
*Can affect central or peripheral airways | *Can affect central or peripheral airways | ||
**burning and irritation to epithelial lining causing airway edema or pulmonary edema, hypoxia, and hypotension | **burning and irritation to epithelial lining causing airway edema or [[pulmonary edema]], [[hypoxia]], and [[hypotension]] | ||
===Pathophysiology=== | |||
=== Pathophysiology === | |||
*Choking agents combine with water in respiratory tract to form acids | *Choking agents combine with water in respiratory tract to form acids | ||
*Both chlorine and phosgene react with water in respiratory tract to form hydrochloric acid | *Both chlorine and phosgene react with water in respiratory tract to form hydrochloric acid | ||
| Line 33: | Line 14: | ||
**Anhydrous, ammonia, Hydrogen chloride, Sulfur dioxide, Formaldehyde | **Anhydrous, ammonia, Hydrogen chloride, Sulfur dioxide, Formaldehyde | ||
**Rapidly react with water causing damage to upper airway to vocal cords | **Rapidly react with water causing damage to upper airway to vocal cords | ||
**Direct tissue damage causing edema/airway obstruction and laryngospasm | **Direct tissue damage causing bronchiolar/alveolar edema/airway obstruction and laryngospasm | ||
**Nasopharyngeal and tracheal [[chemical burns]], upper airway obstruction | |||
**Laryngospasm (can occur immediately upon exposure) | |||
**[[Respiratory distress]]/failure, [[hypoxia]] | |||
**[[Cough]] | |||
**[[Chest pain]] | |||
**[[Arrhythmias]] (hydrochloric acid) | |||
*Moderately water-soluble | *Moderately water-soluble | ||
**Damage to moderate-sized airways (bronchioles) | **Damage to moderate-sized airways (bronchioles) | ||
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**Inhaled deeply into alveoli | **Inhaled deeply into alveoli | ||
**Lack of irritation of mucous membranes can cause them to go undetected | **Lack of irritation of mucous membranes can cause them to go undetected | ||
**[[Respiratory distress]], tachypnea, [[cough]], [[pulmonary edema]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Chemical weapon DDX}} | |||
== | ==Evaluation== | ||
==Management== | ==Management== | ||
*Liquid phosgene can cause off-gassing with release of toxin from clothes post-exposure | *'''Decontaminate''' patient! | ||
**Liquid phosgene can cause off-gassing with release of toxin from clothes post-exposure | |||
*Do not allow patient to be active as it worsens condition | *Do not allow patient to be active as it worsens condition | ||
*Diuretics and corticosteroids not shown to be effective | *Inhaled [[bronchodilators|beta agonists]] for bronchoconstriction | ||
*Diuretics and corticosteroids ''not'' shown to be effective | |||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | |||
[[Category:Pulmonary]] | |||
Latest revision as of 14:34, 13 October 2019
Background
- Include ammonia, methyl isocyanate, methyl bromide, hydrochloric acid and chlorine gas, phosgene
- Common toxic industrial chemicals, transported widely across country
- Can affect central or peripheral airways
- burning and irritation to epithelial lining causing airway edema or pulmonary edema, hypoxia, and hypotension
Pathophysiology
- Choking agents combine with water in respiratory tract to form acids
- Both chlorine and phosgene react with water in respiratory tract to form hydrochloric acid
Clinical Features
Symptoms dependent on the water solubility of the chemical
- Highly water-soluble
- Anhydrous, ammonia, Hydrogen chloride, Sulfur dioxide, Formaldehyde
- Rapidly react with water causing damage to upper airway to vocal cords
- Direct tissue damage causing bronchiolar/alveolar edema/airway obstruction and laryngospasm
- Nasopharyngeal and tracheal chemical burns, upper airway obstruction
- Laryngospasm (can occur immediately upon exposure)
- Respiratory distress/failure, hypoxia
- Cough
- Chest pain
- Arrhythmias (hydrochloric acid)
- Moderately water-soluble
- Damage to moderate-sized airways (bronchioles)
- Bronchospasm and wheezing
- Poorly water-soluble
- Phosgene, Nitrogen dioxide
- Inhaled deeply into alveoli
- Lack of irritation of mucous membranes can cause them to go undetected
- Respiratory distress, tachypnea, cough, pulmonary edema
Differential Diagnosis
Chemical weapons
- Blister chemical agents (Vesicants)
- Lewisite (L)
- Sulfur mustard (H)
- Phosgene oxime (CX)
- Pulmonary chemical agents (Choking agents)
- Incendiary agents
- Cyanide chemical weapon agents (Blood agents)
- Prussic acid (AKA hydrogen cyanide, hydrocyanic acid, or formonitrile)
- Nerve Agents (organophosphates)
- Acetylcholinesterase inhibitors
- Household and commercial pesticides (diazinon and parathion)
- G-series (sarin, tabun, soman)
- V-series (VX)
- Lacrimating or riot-control agents
- Pepper spray
- Chloroacetophenone
- CS
Evaluation
Management
- Decontaminate patient!
- Liquid phosgene can cause off-gassing with release of toxin from clothes post-exposure
- Do not allow patient to be active as it worsens condition
- Inhaled beta agonists for bronchoconstriction
- Diuretics and corticosteroids not shown to be effective