If cyanosis is present, shower with soap and warm water, with special attention to scalp and fingernails; ‏ [books.google.com]

Figure 1: X-ray chest showing bilateral fluffy shadow involving both hilar region Click here to view Discussion This Patient presented to us as case of inhalation injury after accidental leakage of irritant gas from pesticide factory. [ijoem.com]

The physiological response to various concentrations of hydrogen cyanide is presented in Table II. Table II. [web.mit.edu]

Otherwise, treatment is primarily supportive and patients should be observed closely for resolution of the primary presenting symptoms and signs. [clinicaladvisor.com]

• Fatigue

  These symptoms will disappear shortly after exposure stops: Increased levels of carbon monoxide in the blood, which may cause fatigue, shortness of breath or chest pain Drowsiness, headache, a feeling of being "drunk" Eye, skin and lung irritation The [dhs.wisconsin.gov]

  Above this level, symptoms such as headache, fatigue and dizziness appear in healthy individuals. Table I. [web.mit.edu]

  High levels can cause fatigue, irritability and dizziness. Prolonged contact can blister and burn the skin. [pbs.org]

  Headache, and a sense of fatigue in all the limbs, often prostrate the patient. [vlib.us]

  The strong “rotten egg” odor of the gas is not a reliable warning sign for toxicity due to olfactory fatigue at high concentrations or continuous low concentrations. [clinicaladvisor.com]

• Congestive Heart Failure

  […] rate, low blood pressure Blurred vision, burning sensation, excessive tear formation Long-term Effects Respiratory failure, chronic bronchitis, emphysema Cyanosis Irregular pulse, congestive heart failure Blindness,Glaucoma Diagnosis Immediate diagnosis [centerforhealthsecurity.org]

• Cough

  Chlorine gas often caused victims to cough and choke violently; phosgene, by contrast, caused much less coughing, resulting in increased gas inhalation. 2 Military forces even formulated a "white star" concoction consisting of a phosgene-chlorine mix, [centerforhealthsecurity.org]

  After the initial check, the breathing continues, but is gasping in character and interrupted by violent fits of coughing. [vlib.us]

  Chronic exposure damages the lungs; repeated exposure can lead to bronchitis with coughing or shortness of breath. [pbs.org]

  At lower concentrations, it can cause coughing, vomiting, and irritation to the eyes. In its first uses, chlorine was deadly. [compoundchem.com]

  Typical symptoms include wheezing, coughing, tightness in the chest and shortness of breath. [app.croneri.co.uk]

• Dyspnea

  Vesicant toxicity severe enough to cause dyspnea typically causes airway necrosis often with upper airway obstruction. [chemm.nlm.nih.gov]

  Determining factors for return to the emergency department should include cough recurrence, dyspnea (especially resting dyspnea), and chest discomfort. [emedicine.medscape.com]

  Acute inhalation may cause respiratory and circulatory failure with symptoms of chills, dizziness, thirst, burning of eyes,cough, viscous sputum, dyspnea, feeling of suffocation, tracheal rhonchi, burning in throat, vomiting, pain in chest and cyanosis [ruf.rice.edu]

  […] electron transport chain -> inducing anaerobic metabolism Carboxyhemoglobinemia: causes 80% of smoke-inahlation-related deaths Direct Bronchial Mucosal Toxicity Formaldehyde/Chlorine/Phosgene Gas/Nitrogen Dioxide: produce cough/bronchorrhea/wheezing/dyspnea [mdnxs.com]

  Clinically mustard exposures present with dyspnea and wheezing from the pulmonary standpoint. Symptoms are often delayed for hours to days after initial exposure, but subclinical changes occur earlier. [clinicaladvisor.com]

• Painful Cough

  Frequent and painful coughing occurs and some frothy sputum is brought up. [vlib.us]

• Hemoptysis

  The patient did not complain of chest pain, hemoptysis orthopnoea or Paroxysmal Nocturnal Dyspnoea. Initially he was admitted to the nearby hospital and managed conservatively. [ijoem.com]

• Choking

  […] symptoms. 16 Treatment There is no antidote against any of the choking agents. [centerforhealthsecurity.org]

  It is a choking agent that irritates the eyes, nose, and respiratory tract. Symptoms of chlorine poisoning appear as runny nose, coughing, choking, and chest pain. Fluid buildup in the lungs occurs several hours after exposure. Pneumonia can follow. [webmd.com]

  […] it was illogical, and not demonstrably humane, to be tender about asphyxiating men with gas, when all were prepared to admit that it was allowable to blow the bottom out of an ironclad at midnight, throwing four or five hundred men into the sea to be choked [books.google.com]

  […] phosgene casualty who develops respiratory distress within 4 hours of exposure has probably inhaled an LD50 and is at severe risk if not properly supported Signs and symptoms of toxicity may be delayed, although rare, for 24 to 72 hours and include choking [chemm.nlm.nih.gov]

  The gas attacked the lungs, and would cause initial symptoms of coughing, sneezing, vomiting and choking. While phosgene could be used by itself, it was often mixed with chlorine. The gas was largely odorless and didn’t produce a cloud. [warhistoryonline.com]

• Gagging

  We would blow the charge and un-sweat the compresor. 9 times out of 10 you would get a face full of phosgene and gag the hell out of ya. Normal hazzard of the job then with a cancer stick in my mouth. If I only knew then what I know now........ [hvac-talk.com]

• Cyanosis

  […] of the ears reveal the asphyxial cyanosis that underlies the failure of the man to win his fight for life. [vlib.us]

  If cyanosis is present, shower with soap and warm water, with special attention to scalp and fingernails; ‏ [books.google.com]

  […] asphyxiation Dermatitis, discoloration, blisters, burning sensation, chemical burns Slow heart rate, low blood pressure Blurred vision, burning sensation, excessive tear formation Long-term Effects Respiratory failure, chronic bronchitis, emphysema Cyanosis [centerforhealthsecurity.org]

  Early cyanosis carries a near-hopeless prognosis. Gastroenterological : nausea and vomiting, oesophageal perforation at high levels. Neurological : headache, disorientation. [patient.info]

• Blepharospasm

  Link to PPE, rescuer safety hospital management section Link to reference section for acute event PPE related safety information Immediate irritant effects such as conjunctivitis, rhinitis, pharyngitis, bronchitis, lacrimation, blepharospasm conjunctival [chemm.nlm.nih.gov]

  Eye irritation - red eyes, tearing, blepharospasm. ENT irritation: chronic sore throat, rhinorrhoea, hypersalivation, stridor. [patient.info]

• Eye Pain

  Eyes: Nerve agent liquid or vapor readily penetrates the eye tissues and may cause the pupils to contract, blurred and dim vision, headache, redness, tears, pain, nausea, and vomiting. [emedicinehealth.com]

• Headache

  Symptoms include visual problems, headache, runny nose and nasal congestion, salivation, tightness of chest, nausea and vomiting, anxiety, confusion, involuntary muscle movements, and involuntary bowel movement and urination. [webmd.com]

  Inhalation may cause headache, delirium, nausea, vomiting, general malaise, tightness in the chest and pain in the abdomen or loins. Arsine does not have adequate warning properties to avoid overexposure. [ruf.rice.edu]

  Acute exposure can severely irritate the eyes, skin, and nose, and can cause headaches, nausea, dizziness, unconsciousness, and death. [pbs.org]

  Very low concentrations (e.g., one part per million) cause headaches and dryness of the eyes. Chronic effects include significant changes in lung function. [ccohs.ca]

  Headache, vertigo and dyspepsia may continue for several weeks. Prognosis. Nothing is known as to the proportion of men who die from "gassing" on the field. [vlib.us]

If cardiogenic pulmonary edema is strongly suspected Findings on chest radiography are as follows: Initial films may be normal Early changes include hyperinflation and hilar enlargement Later changes are typical for noncardiogenic pulmonary edema See Workup [emedicine.medscape.com]

RCRA defines a solid waste as:. .. any garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or air pollution control facility and other discarded material, including solid, liquid, semisolid, or contained gaseous material [books.google.com]

2.0 atm decreases COHb half-life to approximately 20 min However, the use of hyperbaric oxygen is controversial and is not recommended for COHb Treatment of Cyanide Toxicity (if suspected) Treatment utilizies induction of methemoglobinemia -> use of [mdnxs.com]

There are no guidelines regarding the treatment of phosgene poisoning during pregnancy. Owing to the severity of complications associated with phosgene poisoning, treatment of the pregnant patient should be the same as for the non-pregnant patient. [medicinesinpregnancy.org]

Treatment with the iNOS inhibitor aminoguanidine aerosol by inhalation reduced the severity of phosgene-induced ALI when applied at low dose-rates. Symptomatic treatment regimens were considered inferior to causal modes of treatment. [unboundmedicine.com]

Therapeutic treatments of phosgene-induced lung injury. Inhal Toxicol 2004;16:565-80. 9. Sciuto AM, Strickland PT, Kennedy TP, Gurtner GH. Protective effects of N-acetylcysteine treatment after phosgene exposure in rabbits. [ijoem.com]

Prognosis of lung irritant cases. [vlib.us]

Early hypoxaemia has a poor prognosis. [patient.info]

Seizures (see Seizures, [[Seizures]]) Chest Pain (see Chest Pain, [[Chest Pain]]) Carboxyhemoglobinemia (see Carboxyhemoglobinemia, [[Carboxyhemoglobinemia]]) Physiology: related to exposure levels of CO Diagnosis ABG Co-Oximetry: carboxyhemoglobinemia Prognosis [mdnxs.com]

Mustards Prognosis Victims with significant respiratory tract burns usually require admission to the hospital’s intensive care unit. [emedicinehealth.com]

Alveoli may collapse, resulting in significant ventilation/perfusion (V/Q) mismatch, unless the patient receives ventilatory support with positive end-expiratory pressure (PEEP) Etiology Phosgene exposure may result from any of the following [11] : Small-scale [emedicine.medscape.com]

[…] relationship between COHb level and the long-term neurologic outcome Methemoglobinemia (see Methemoglobinemia, [[Methemoglobinemia]]) Physiology: related to exposure to oxidants Acute Bronchospasm (see Obstructive Lung Disease, [[Obstructive Lung Disease]]) Epidemiology [mdnxs.com]

Epidemiology Due to lack of consistent diagnostic methods, the incidence of inhalation injury from all chemical irritants is not readily available. [clinicaladvisor.com]

A chart of signs and symptoms is available from the North Carolina Statewide Program for Infection Control and Epidemiology. [emedicinehealth.com]

Epidemiology According to OSHA, millions of kilograms of phosgene are produced annually, with 10,000 workers at risk of exposure. [emedicine.medscape.com]

Pathophysiology Inhalation of toxic gases leads to injury through a variety of mechanisms. [clinicaladvisor.com]

Because phosgene is poorly soluble in water, it reacts minimally with oropharyngeal and conducting airway tissues and as a result can penetrate deeply into the lung, where it exerts its effects at the alveolar-capillary membrane (see Pathophysiology). [emedicine.medscape.com]

Pathophysiology [ 10 ] Chlorine gas is classed as a pulmonary agent or choking agent (others include phosgene, diphosgene and chloropicrin). [patient.info]

It is also produced in the presence of refrigerants that are drawn through a heat source, refrigeration technicians should take extreme caution and prevent the exposure by making sure that smoking is avoided in the presence of refrigerants and preventing [c-f-c.com]

Every necessary precaution has been taken to prevent its being communicated to this army ; and the General Court will take care, that it does not spread through the country. [books.google.com]

[…] inquiries: [email protected] Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Pocket Guide to Chemical Hazards The Centers for Disease Control and Prevention (CDC) protects people’s health [emergency.cdc.gov]

(ERG, 2016) Protective Clothing Skin: If chemical is in liquid form, wear appropriate personal protective clothing to prevent skin contact. Eyes: If chemical is in liquid form, wear appropriate eye protection to prevent eye contact. [cameochemicals.noaa.gov]

US Centers for Disease Control and Prevention, Emergency Preparedness and Response website. April 12, 2013. https://emergency.cdc.gov/agent/phosgene/basics/facts.asp. Accessed February 26, 2014. Facts about chlorine. [centerforhealthsecurity.org]