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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
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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.Source: OSHA
During chemical operations, it is not always apparent when exposure occurs.
Many chemicals pose invisible hazards and offer no warning properties.
Source: OSHA
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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 acidNaOCl = sodium hypochlorite (bleach)Cl = chlorineCl2 = chlorine gasNH2Cl = chloramineN2H4 = 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
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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 coagulativenecrosis
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
Asphyxiant ‐ Simple
• Carbon Dioxide
• Methane
• Propane
• Displace oxygen from atmosphere
Asphyxiant ‐ Systemic
• Isobutyl Nitrite
• Carbon Monoxide
• Hydrogen Cyanide
• Hydrogen Sulfide
• Hydrogen Azide
• Interfere with oxygen transport & utilization
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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
• Bind to acetylcholinesterase causing accumulation of acetylcholine
• Affects muscarinic and nicotinic receptors
• Muscarinic: SLUDGEM
• Nicotinic: MTWHF
SLUDGEM vs MTWHF
Muscarinic
• Salivation
• Lacrimation
• Urination
• Defecation
• Gastroenteritis
• Emesis
• Muscle Tremors/Miosis
Nicotinic
• Mydriasis
• Tachycardia
• Weakness
• Hypertension
• Fasiculations
CNS
• Anxiety • Crying/Laughing• Restlessness • Confusion • Ataxia • Tremors • Seizures • Coma
For the Paramedics
• 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)
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Treatment
• Remove all clothing
• Decontaminate
• Airway management
• Pulse oximeter
• Capnography
• Medicate
• DuoDote
– Pralidoxime Chloride 600mg
– Atropine Sulfate 2.1mg
• Diazepam
Corrosives
• 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
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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
amanita muscaria
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 0.2‐0.3ml/kg IV
Antidotes – Calcium Chloride
• Hydrogen Flouridetoxicity– Hypocalcemia
– Hypomagnesemia
– Hyperkalemia
• Calcium Channel Blocker Overdose
• Calcium Gluconate– 4.6 mEq per 10ml
• Calcium Chloride– 13.6 mEq per 10ml
• IV only
• Adult 0.5gm – 1gm (5‐10ml)
• Ped 0.1 – 0.2 ml
Antidotes – Amyl Nitrite
• Cyanide poisoning (replaced with Cyanokit)
• Sulfide poisoning (questionable)
Antidotes – Sodium Nitrite
• Cyanide poisoning (replaced with Cyanokit)
• Sulfide poisoning (questionable)
– Instead use IV fluids and vasopressors to treat hypovolemia
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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 gamma‐aminobutyric acid (GABA)
End Note……