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]

• Collapse

  At any time however, particularly if subjected to much physical effort, those cases may rapidly pass into the most dangerous condition of "grey" cyanosis and collapse. The pulse becomes rapid, thready and irregular. [vlib.us]

  In high doses, the effects are quick and catastrophic, including gasping for breath, seizures, the collapse of the cardiovascular system and coma. Death comes within minutes. The gas is flammable and potentially explosive. [dailypress.com]

  In the event that a high level of HCN has been absorbed into the body, collapse is usually instantaneous, followed quickly by unconsciousness, convulsions and almost immediate death. [firefighternation.com]

  Ten days after the incident, he was at home when he collapsed. EMS found him to be in cardiac arrest, and efforts to resuscitate him were not successful. [firerecruit.com]

• Unconsciousness

  In severe poisoning unconsciousness follows; nothing more is known about the cases which prove fatal on the field within the first few hours of the "gassing," except that the face assumes a pale greenish yellow colour. [vlib.us]

  In extreme cases, short-term exposure to higher levels of this chemical can cause unconsciousness and death. [envirofluid.com]

  High concentrations may result in unconsciousness and death Hydrogen Fluoride Decomposition of rod coatings. Irritating to the eyes and respiratory tract. Overexposure can cause lung, kidney, bone and liver damage. [ccohs.ca]

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

  In the event that a high level of HCN has been absorbed into the body, collapse is usually instantaneous, followed quickly by unconsciousness, convulsions and almost immediate death. [firefighternation.com]

• Disability

  Chronic exposure of bauxite dust and asbestos can lead to damage of lung function causing disability and even death. [clearwatersolicitors.co.uk]

  When soman disables that enzyme, the neurotransmitters go wild. [theraptorlab.wordpress.com]

  But a small proportion did develop permanent disability, with progressive dyspnoea, recurrent bronchitis and a radiographic picture of scattered fibrosis and emphysema in the lungs. [vlib.us]

  According to the Imperial War Museum, of the roughly 600,000 disability pensions still being paid to British servicemen by 1929, only 1% were being given to those classed as victims of gas. [bbc.com]

  They state that as many as three million people have developed illness because of Agent Orange while the Red Cross of Vietnam estimates that up to one million people were disabled or have health problems associated with Agent Orange. [en.wikipedia.org]

• 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]

  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]

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

• 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

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

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

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

  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]

  CS gas produces in addition profuse coughing, disorientation, difficulty breathing, and vomiting. However, it does not cause pulmonary oedema at the levels seen in crowd-control situations [ 15 ]. [patient.info]

• Dyspnea

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

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

  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]

• Sputum

  Symptoms may include irritation of the eyes or nose, cough, blood in the sputum, and shortness of breath. Chest x-rays, computed tomography, and breathing tests are used to determine how much lung damage has occurred. [merckmanuals.com]

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

  […] 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, chest tightness, cough, severe dyspnea, production of foaming bloody sputum [chemm.nlm.nih.gov]

  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]

• 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]

  The skin and mucous membrane damage occurs the same way the choking agents work: absorption into your watery body through inhalation or skin contact. [theraptorlab.wordpress.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]

• 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]

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

  […] 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]

• Sweating

  Symptoms include runny nose, tightness of chest, dimmed vision, breathing difficulty, drooling, excessive sweating, nausea and vomiting, involuntary defecation and urination, involuntary muscle movements, headache, confusion, and drowsiness. [webmd.com]

  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]

  Skin absorption of TEDP leads to localized sweating and muscular twitching in the affected area. [ruf.rice.edu]

  Short term exposure to higher levels of Tetrachloroethylene can cause build-up of fluid in the lungs, respiratory irritation, severe shortness of breath, sweating, nausea and vomiting. [envirofluid.com]

  Atropine also blocks other effects of poisoning, such as nausea, vomiting, abdominal cramping, low heart rate, and sweating. Atropine, however, does not prevent or reverse paralysis. [emedicinehealth.com]

• Flushing

  Eyes and skin should be flushed thoroughly if exposed. [webmd.com]

  Immediately flush the contaminated eye(s) with water for at least 15 minutes. Seek medical attention immediately. [baylor.edu]

  SKIN OR EYES: immediately flush skin or eyes with plenty of water for at least 15 mm. If cyanosis is present, shower with soap and warm water, with special attention to scalp and fingernails; ‏ [books.google.com]

  If eye exposure has occurred, eyes must be flushed with lukewarm water for at least 15 minutes. 5. Wash exposed skin areas THOROUGHLY with soap and water. 6. [cameochemicals.noaa.gov]

  At this stage casualties can be divided into three types : (a) The milder case, with reddish flush in the face, with some hurry of respiration, and with pain in the chest and epigastrium which is increased by coughing. [vlib.us]

• 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]

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

  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]

  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]

  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]

• Dizziness

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

  Dizziness, mental confusion, asphyxiation and death. Ozone Formed in the welding arc, especially during plasma-arc, MIG and TIG processes. Acute effects include fluid in the lungs and hemorrhaging. [ccohs.ca]

  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]

  Short-term exposure: Low levels of Tetrachloroethylene vapour can irritate eyes, nose, mouth, throat and respiratory tract, and cause dizziness, headache, sleepiness and confusion. Direct contact with skin causes irritation and discomfort. [envirofluid.com]

  Many solvents have a narcotic effect; they may cause dizziness, headache, reduced comprehension or tiredness. They may also irritate the eyes and the respiratory tract. [ilo.org]

• Convulsions

  In the event that a high level of HCN has been absorbed into the body, collapse is usually instantaneous, followed quickly by unconsciousness, convulsions and almost immediate death. [firefighternation.com]

  The signs and symptoms of TEDP poisoning by any route may progress to giddiness, slurred speech, incoordination, muscle weakness, convulsions, loss of reflexes, coma, respiratory paralysis, and death. [ruf.rice.edu]

  Severe exposure can lead to convulsions and respiratory failure. Antidotes are atropine, pralidoxmine, and a benzodiazepine. Eyes and skin should be flushed thoroughly if exposed. [webmd.com]

  High levels can lead rapidly to convulsions or sudden death. Chronic exposure damages the thyroid gland and nervous system. [pbs.org]

  In contrast, people with severe liquid exposures may show no symptoms (for 1-30 minutes) but rapidly may suffer abrupt loss of consciousness, convulsions, generalized muscular twitching, paralysis, secretions (from the nose, mouth, lungs), difficulty [emedicinehealth.com]

• Vertigo

  Seizures follow within 15 to 30 seconds, accompanied by vertigo and vomiting. Death is likely in six to eight minutes. [dailypress.com]

  Acute exposure to HCN can result in symptoms such as weakness, headache, confusion, vertigo, dyspnea and, occasionally, nausea and vomiting. [firefighternation.com]

  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]

• Agitation

  HCN, on the other hand, targets the central nervous system, cardiovascular system, thyroid and the blood, causing firefighters to become disoriented and agitated, and to lose focus on the task at hand. [firefighternation.com]

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]

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: Both hydroxocobalamine or a combination of nitrite/sodium thiosulfate are approved for treatment of cyanide poisoning in the United States. [clinicaladvisor.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]

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]

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

Prognosis of lung irritant cases. [vlib.us]

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

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]

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]

[…] 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]

Preventive action To prevent or minimise respiratory problems at work, lab managers should have a respiratory protection management programme in place. The programme should cover the following. Risk assessment. [app.croneri.co.uk]

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]

Decontamination after the first few minutes of exposure does not prevent further damage later but at least prevents spread of the chemical to other parts of the body and protects emergency care personnel from further contact exposure. [emedicinehealth.com]