Re: protocol question

[Guest guest]

Donn,

When I worked offshore we kept Lenses at all times. We also kept

Pentocaine or Tetracaine for analgesia. Our protocols did differentiate between

acids and alkalines. For acids we were to irrigate with NS for a minimum of 30

minutes; for alkalis a minimum of one hour.

Hydrofluoric acid is nasty, nasty stuff. It penetrates the tissues and does

damage to the deep tissues. The stronger solutions (70%, 49%) cause immediate

pain; however more dilute solutions can be very dangerous because they can

penetrate and do damage before they cause significant pain.

We kept calcium gluconate gel on hand when hydrofluoric acid was present.

At Shackelford County EMS we do not have a specific protocol for eye injury

nor do we carry Pentocaine or calcium gluconate gel.

GG

In a message dated 12/31/2003 3:54:56 AM Central Standard Time,

donn.barnes@... writes:

Howdy folks,

Regarding ocular chemical burns, do your protocols mention the

difference between acid and alkali? If so, what are the differences in

your treatment options?

Regarding exposure to acidic compounds, do your protocols mention

hydrofluoric acid? If so, specifically for ocular exposure, do your

treatment options vary?

Do you carry calcium gluconate?

Do you carry the Lens?

Do you carry topical ocular anastethetics or have protocol for ocular

pain relief following chemical exposure?

Thanks,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

~~ Ubi dubium ibi libertas ~~

[Guest guest]

In most services it is probably rare. I work in an industrial

environment where use of caustics and acids is common, but we take

plenty of precautions and our incident rate is low. Still we must be

prepared in the event someone gets careless.

I asked the original question specific to hydrofluoric acid because a

burn by this compound must be treated very much differently than any

other acid. Hydrofluoric acid exposure can be a true life-threatening

emergency. Any other acid in the eyes presents with a usually self-

limiting injury. HF in the eyes can result is total and permanant loss

of vision if not treated correctly and rapidly. Our basic HF protocol

follows:

Regards,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

~~ Ubi dubium ibi libertas ~~

Hydrofluoric acid:

A colorless to yellow liquid with a strong, irritating odor. Since the

boiling point of HF is 67º F, when exposed to air, HF will readily

change to a gaseous state. When HF comes in contact with metals it

forms hydrogen gas which is extremely flammable. Once HF is absorbed

into the tissues it binds to calcium and magnesium. This form of

fluoride poisoning can be fatal, even if exposure is due to a dilute

solution (<3%). As little as 7 ml of 100% solution can cause death.

Signs and symptoms:

Hypovolemic shock and collapse, tachycardia with weak pulse, acute

pulmonary edema, asphyxia, chemical pneumonitits, upper airway

obstruction with stridor, pain and cough, decreased LOC,

nausea/vomiting, diarrhea, possible GI bleeding, and possible

blindness. HF also causes severe skin burns. The damage may be severe

with no outward signs, except that the patient will complain of severe

pain.

1) Remove patient from hazardous area.

2) If patient was exposed externally, remove clothing and

3) Decontaminate with copious amounts of any reasonably clean liquid.

4) Ipecac is contraindicated.

5) Contact Poison Information Center.

a) For skin involvment:

i) Immediately flush with copious amounts of water.

ii) Prepare skin gel mixing calcium gluconate (10%) 10ml into a

2oz. tube of KY jelly (making a 2.5% gel).

iii) Apply a 2.5% calcium gluconate gel on burned area.

For ocular involvment:

i) Immediately flush with copious amounts of water or normal

saline.

ii) Continue flush as you prepare a 10% calcium gluconate eye wash

solution by mixing 50 ml in NS 500 ml.

iii) Apply calcium gluconate eye wash via Lens and continue

until arrival at receiving facility.

c) For inhalation injury:

i) Immediately support ventilations.

ii) Prepare a nebulizer treatment by adding calcium gluconate (10%)

3 ml to sterile water 6ml in nebulizer.

iii) Administer nebulizer treatment and adjust oxygen flow to

provide sufficient fog (e.g. 6-8 L/minute).

iv) If S & S of pulmonary edema, maintain adequate ventilation and

oxygenation.

v) Suction PRN.

vi) Non-cardiogenic pulmonary edema should not be treated with

furosemide, but with positive and expiratory pressure (PEEP).

6) Treat disrhythmias PRN.

7) If hypotension persists treat PRN.

8) Consider calcium gluconate slow IVP if systemic symptoms persist.

9) Emergent evacuation to nearest appropriate medical facility.

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From: BCarney1123@...

Sent: Wednesday, December 31, 2003 1:04 PM

To: Paramedicine

Subject: Re: protocol question

In a message dated 12/31/2003 11:34:13 AM Eastern Standard Time,

dpoetter@... writes:

> We carry Proparacain and it is used for foreign bodies and chemical

> burns to the eye. one drop every minute up to 4. W irrigate for

burns

> and do not neutralize except bases or acids I can send you a copy of

> our protocol if you would like it. The protocol was

> written by and

> Opthamologist who is also a Paramedic in our count.

I like a copy of the protocol. How often do you folks use it. I've been

a medic for 17 years and have a hard time trying to remember any jobs

were we could have used it.

M. Carney, EMT-P

East Brunswick, NJ