Protocol 25 Hazardous Materials Toxicology 12/31/2020
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Questions and Answers

What is the primary goal of emergency personnel in a hazardous materials incident?

  • Ensuring the safety of rescue personnel. (correct)
  • Securing the area from media presence.
  • Providing access to medical records of patients.
  • Obtaining legal documentation for the incident.

    • Which of the following should be the initial step in addressing a victim of hazardous material exposure?

  • Immediate chemical specific ALS treatment.
  • Perform a gross decontamination of the patient. (correct)
  • Initiate a detailed patient history assessment.
  • Locate the victim's family for consent.

    • What must not be overlooked when treating a chemically contaminated patient?

  • Potential legal liabilities.
  • Hospital admission procedures.
  • Possibility of underlying trauma or impaired consciousness. (correct)
  • The psychological state of the patient.

    • Which unit is specifically responsible for chemical specific antidote therapy in hazardous material incidents?

    <p>Hazardous Materials Response Unit.</p> Signup and view all the answers

    Under what condition should chemical specific ALS treatment modalities be utilized?

    <p>When the contaminant is positively identified.</p> Signup and view all the answers

    What should responders do upon identifying a hazardous material?

    <p>Search for its safety data sheet via reliable references.</p> Signup and view all the answers

    Which reference can be consulted for guidance on hazardous materials incidents?

    <p>North American Emergency Response Guidebook.</p> Signup and view all the answers

    Who is responsible for initiating special antidote therapy in a hazardous materials scenario?

    <p>Department certified Hazmat Medic.</p> Signup and view all the answers

    What is the primary purpose of administering Atropine to a patient exposed to a chemical nerve agent?

    <p>To promote the drying of pulmonary secretions</p> Signup and view all the answers

    Which of the following symptoms is least associated with exposure to chemical nerve agents?

    <p>Drowsiness and decreased alertness</p> Signup and view all the answers

    What is the maximum initial dose of Midazolam that can be administered for seizure management?

    <p>5 mg</p> Signup and view all the answers

    In the event of shortness of breath after exposure to a chemical nerve agent, what is the first-line intervention?

    <p>Administer oxygen via a non-rebreather mask</p> Signup and view all the answers

    What indicates successful treatment of a patient with Atropine after chemical nerve agent exposure?

    <p>Drying of all pulmonary secretions</p> Signup and view all the answers

    What is the primary treatment protocol for a patient exhibiting extreme toxicity from hydrogen sulfide exposure?

    <p>Deliver Sodium Nitrite 300 mg IVP after Amyl Nitrite.</p> Signup and view all the answers

    Which symptom is indicative of severe methemoglobinemia as a result of nitrogen-containing compounds exposure?

    <p>Chocolate brown blood and cyanosis.</p> Signup and view all the answers

    What should be done first when treating a patient exposed to hydrofluoric acid?

    <p>Flood the affected area with water for at least one minute.</p> Signup and view all the answers

    Which condition is primarily treated with Methylene Blue administration?

    <p>Methemoglobinemia.</p> Signup and view all the answers

    What is the appropriate action for a patient with cardiac arrest due to hydrofluoric acid exposure?

    <p>Provide Calcium Chloride 1 gm slow IV/IO.</p> Signup and view all the answers

    What characteristic distinguishes hydrogen sulfide from mercaptans?

    <p>Mercaptans are used as odorants in natural gases.</p> Signup and view all the answers

    How should Amyl Nitrite be administered when treating hydrogen sulfide toxicity?

    <p>For 30 seconds every minute using fresh inhalants.</p> Signup and view all the answers

    Which of the following reactions may occur due to exposure to acid mist or chlorine?

    <p>Rapid onset of eye and mucous membrane irritation.</p> Signup and view all the answers

    In what scenario should Sodium Thiosulfate NOT be administered?

    <p>After Sodium Nitrite for cyanide poisoning.</p> Signup and view all the answers

    What is a common symptom of high concentration exposure to hydrogen sulfide?

    <p>Olfactory paralysis.</p> Signup and view all the answers

    Why is it crucial to avoid using Epinephrine in cases of bronchospasm caused by hydrocarbons?

    <p>Epinephrine exacerbates cardiac sensitization.</p> Signup and view all the answers

    What complication can arise from the systemic absorption of hydrofluoric acid?

    <p>Cardiac arrest.</p> Signup and view all the answers

    What is vital to monitor after administering Methylene Blue for methemoglobinemia?

    <p>Blood pressure and respiratory distress.</p> Signup and view all the answers

    What is one of the primary dangers of Carbon Monoxide (CO) exposure?

    <p>It reduces blood oxygen carrying capacity</p> Signup and view all the answers

    What immediate treatment should be initiated for a patient with acid mist exposure?

    <p>Begin oxygen therapy.</p> Signup and view all the answers

    Which symptom is NOT an early sign of Carbon Monoxide poisoning?

    <p>Cherry red skin color</p> Signup and view all the answers

    What percentage of carboxyhemoglobin (SpCO) requires ALS transport to the closest appropriate facility?

    <p>≥13%</p> Signup and view all the answers

    How do Organophosphates and Carbamates primarily cause toxicity in the body?

    <p>By inhibiting cholinesterase activity</p> Signup and view all the answers

    What mnemonic is used to remember the classic signs of Organophosphate & Carbamate poisoning?

    <p>SLUDGE</p> Signup and view all the answers

    Which of these is a serious symptom associated with the 'Killer Bs' of Organophosphate poisoning?

    <p>Bradycardia</p> Signup and view all the answers

    What is the immediate BLS action for a patient exhibiting severe symptoms of Organophosphate poisoning?

    <p>Administer Atropine 2 mg IV/IO</p> Signup and view all the answers

    Cyanide exposure primarily affects which cellular function?

    <p>Oxygen utilization</p> Signup and view all the answers

    What is the fastest recognizable effect of Cyanide inhalation?

    <p>Respiratory failure</p> Signup and view all the answers

    What is the primary treatment for Cyanide poisoning in adults?

    <p>Hydroxocobalamin (CyanoKit)</p> Signup and view all the answers

    When using the RAD-57 Procedure 44, what is measured to assess Carbon Monoxide exposure?

    <p>Carboxyhemoglobin percentage</p> Signup and view all the answers

    What role does Atropine play in treating Organophosphate poisoning?

    <p>Decreases gastrointestinal activity</p> Signup and view all the answers

    Which condition can occur from exposure to hydrocarbon-based solvents mixed with pesticides?

    <p>Upper respiratory irritation</p> Signup and view all the answers

    In what progression order do symptoms of Cyanide poisoning typically occur?

    <p>CNS, respiratory, cardiovascular</p> Signup and view all the answers

    Study Notes

    Emergency Personnel Goals

    • Ensure the safety of rescue personnel during hazardous materials incidents.
    • Remove patients from danger and perform patient decontamination.
    • Provide definitive treatment following standardized protocols.
    • Hazmat units have expanded drug inventories and specialized antidote therapy initiated by certified Hazmat Medics.

    Patient Assessment Protocols

    • Treat patients suspected of chemical contamination while considering potential underlying conditions.
    • Identify the hazardous substance using reference guides:
      • North American Emergency Response Guidebook
      • NIOSH Pocket Guide
      • Emergency Care for Hazardous Materials Exposure
      • Handbook of Poisoning
      • Poison Control Center (1-800-222-1222)
    • Separate victims from hazardous agents, using trained personnel equipped with appropriate PPE.

    General Care (EMR/BLS)

    • Conduct primary assessment while initiating gross decontamination.
    • Address life-threatening emergencies before focusing on decontamination and supportive measures.
    • Chemical-specific ALS treatments only for identified contaminants or symptomatic cases consistent with known exposures.

    Carbon Monoxide (CO) Overview

    • CO is a colorless, odorless gas, a byproduct of incomplete combustion.
    • Binds with hemoglobin to form carboxyhemoglobin, impairing oxygen transport in blood.
    • Symptoms include headache, dizziness, chest pain, and severe cases can lead to seizures or coma.

    BLS for CO Exposure

    • Remove patients from contaminated environments.
    • Use RAD-57 Procedure 44 to measure SpCO levels.
    • Administer oxygen via NRB mask at 15 L/min or ventilate with BVM if unresponsive.

    ALS for CO Exposure

    • Initiate airway management if needed; intubate if required.
    • Administer Narcan (0.5 mg IV/IM) for respiratory depression signs, following CO poisoning protocols.
    • Transport based on SpCO levels; higher levels necessitate ALS transport to appropriate facilities.

    Organophosphates & Carbamates

    • Organophosphate insecticides are absorbed through skin, GI tract, and respiratory tract; Carbamates less so.
    • Inhibit cholinesterase, leading to excess acetylcholine accumulation and overstimulation of the nervous system.
    • Symptoms can be remembered using mnemonics “SLUDGE” (muscarinic symptoms) or “DUMBELS” (nicotinic symptoms).

    BLS for Organophosphate Exposure

    • Administer oxygen via NRB mask and suction airway as needed.

    ALS for Organophosphate Exposure

    • Administer Atropine (2 mg IV/IO) based on symptom severity; repeat as needed.
    • Manage seizures with Midazolam (5 mg slow IV/IM/IO) until control is achieved.

    Cyanide (CN) Symptoms

    • Extremely toxic; affects oxygen utilization at the cellular level.
    • Exposure can lead to rapid onset neuro, cardio, and respiratory symptoms.
    • Death can occur within minutes after inhalation.

    BLS for Cyanide Exposure

    • Document carboxyhemoglobin readings and initiate oxygen therapy.

    ALS for Cyanide Exposure

    • Implement airway management and establish vascular access.
    • Administer Hydroxocobalamin (5 gm IV over approximately 15 minutes); Sodium Thiosulfate if necessary.

    Hydrogen Sulfides & Mercaptans

    • H2S is a colorless gas with a rotten egg odor; highly toxic and can cause olfactory paralysis.
    • Exposure leads to acute respiratory symptoms or syncope in high concentrations.

    BLS for Hydrogen Sulfide Exposure

    • Administer oxygen via NRB mask.

    Adult Care for Hydrogen Sulfide Exposure

    • Use Amyl Nitrite inhalants while providing oxygen.
    • Administer Sodium Nitrite IV after Amyl Nitrite therapy.

    Nitrogen-Containing Compounds

    • Found in household products and associated with methemoglobinemia.
    • Cyanotic appearance indicates significant impairment in oxygen transport.

    BLS for Nitrogen-Containing Compounds

    • Administer oxygen via NRB mask.

    Adult Care for Nitrogen-Containing Compounds

    • Methylene Blue (1-2 mg/kg IVP) if altered mental status is evident.

    Hydrofluoric Acid (HF) Characteristics

    • HF exposure causes intense painful burns exceeding visible injury areas.
    • Systemic absorption can lead to severe outcomes like cardiac arrest.

    BLS for HF Exposure

    • Provide oxygen via NRB mask.

    Adult Care for HF Exposure

    • Use PPE and decontaminate affected skin; apply Calcium Gluconate Gel.

    Aromatic Hydrocarbons & Gasoline

    • Inhalation can cause serious cardiac dysrhythmias.

    Adult Care for Inhaled Hydrocarbons

    • Treat tachydysrhythmias per protocols; avoid administering Epinephrine.

    Acid Mist/Chlorine & Ammonia Gas

    • Low concentrations produce irritations; higher levels can lead to pulmonary edema.

    BLS for Acid Mist/Chlorine Inhalations

    • Administer oxygen via NRB mask, followed by ALS for further management.

    Chemical Nerve Agents

    • Organophosphates (e.g., Tabun, Sarin) require immediate care due to severe absorption through skin.

    BLS for Chemical Nerve Agents

    • Provide oxygen and manage airway issues promptly.

    ALS for Chemical Nerve Agents

    • Administer Atropine and manage seizures with Midazolam; continuous monitoring of symptoms is essential.

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    Description

    This quiz focuses on the primary goals of emergency personnel during hazardous materials incidents, including nuclear, biological, and chemical threats. Key areas include the safety of rescue personnel, patient removal, decontamination, and definitive treatment protocols. Test your knowledge on the procedures and protocols essential for managing symptomatic patients in such critical situations.

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