0071643192.pdf

CAUSES

Common substances and their sources are found in Table 10.20.

SYMPTOMS/EXAM

■ Phosgene:Odor of freshly mowed hay, respiratory irritation, skin irritation

■ Chlorine:Distinctive odor of “swimming pool”; ocular and respiratory;

nausea and vomiting are common

■ Nitrogen oxides: Triphasic illness of flulike symptoms followed by tran-

sient improvement, then pulmonary edema

■ Ammonia: Distinctive odor of cleaning product, severe mucous mem-

brane irritation

■ Hydrocarbons:Odor may be noted; respiratory irritation; stimulation fol-

lowed by ↓alertness

■ Hydrogen sulfide:Odor of rotten eggs, ocular and respiratory irritation;

high concentrations cause rapid LOC and seizures

DIAGNOSIS

■ Clinical diagnosis primarily from history of exposure

■ Helpful studies may include ABG with COHb and MetHb levels, lactate,

RBC cyanide levels, ECG, and CXR.

TREATMENT

■ Removal from source

■ 100% O 2

■ Irrigation of exposed areas, especially eyes and skin

THORACIC AND RESPIRATORY

DISORDERS

TABLE 10.20. Common Toxic Gases, Fumes, and Vapors

SUBSTANCE SOURCE TOXICITY

Phosgene Plastics, textiles, Hydrolyzes to CO 2 and HCl

pharmaceuticals

Chlorine Water purification, paper Forms acids and oxidants causing

manufacturing inflammation

Nitrogen oxide Combustion Converts to nitric acid; causes delayed

alveolar injury and pulmonary edema

Ammonia Fertilizers Forms ammonium hydroxide

Hydrocarbons Fuels, lubricants, Depends on physical characteristics

cleaning solvents (volatility, viscocity, and surface tension),

chemical characteristics (aliphatic,

aromatic, or halogenated) and presence

of toxic additives

Hydrogen Organic decomposition Disrupts oxidative phosphorylation

sulfide causing cellular asphyxia and anaerobic

metabolismsimilar to cyanide