Carbon monoxide and cyanide gas poisoning in fires. / Forgiftning med karbonmonoksid og cyanidgass ved brann.

Acute poisoning caused by inhalation of carbon monoxide and other toxic substances is the primary cause of death in fires and may occur without signs of external injury. Life-threatening symptoms may arise immediately, as in cyanide poisoning, or over a longer period, as in carbon monoxide poisoning. Severe inhalation injury may also occur independently of systemic poisoning and should always be suspected in patients with soot on their face and in the respiratory tract, or hoarseness and wheezing.

Recent sulfur mustard attacks in Middle East and experience of health professionals.

Sulfur mustard (SM) is a vesicant chemical warfare agent which affects ocular, respiratory, and cutaneous system. In this study, we aimed to share recent experiences on medical management of chemical casualties that were exposed to SM in Middle East. We reported medical management of 17 contaminated patients. After the evacuation from the hot zone, all chemical casualties should be transferred to the designated intensive care units. After detailed medical decontamination and stabilization, biological samples should be collected from all chemical casualties as soon as possible for the verification of the exposure. Medical history and existing symptoms reveal the clinical diagnosis of SM exposure. Medical management of SM casualties should focus on "good nursing care" including treatment of pain and itching, fluid and electrolyte replacement therapy, respiration and nutrition support. Despite of improved clinical skills, treatment of SM lesions is still non-specific which aims to relieve symptoms and to prevent infections. Existing diagnostic capabilities and treatment approaches could be improved by sharing recent clinical experiences on medical management of SM casualties where there are still important major gaps.

Hydrogen sulfide gas poisoning in fish garbage room: A report of a fisherman.

We report the case of a fisherman who was exposed to high concentrations of hydrogen sulfide (H2S) gas from the fish garbage room. The patient survived and was discharged with full recovery from the hospital. H2S is a colourless, foul smelling and highly toxic gas next to carbon monoxide, which causes inhalation death. It is a by-product of various industrial processes particularly involves exposure from agriculture, petrochemical industry and organic matter decomposition from sewage processing. It is a by-product of H2S has been referred as the "knock down gas" because inhalation of high concentrations can cause immediate loss of consciousness and death. Although early use of amyl nitrate and hyperbaric oxygen shows some benefit in literature, supportive care remains the mainstay of treatment. Emergency physicians and pre-hospital care personnel are not very familiar with such exposure due to its rarity. This becomes more relevant in the developing world settings where there are rising concerns about the unsafe exposure to hazardous chemicals and its impact on human health. Emergency physicians working in Pakistan should be aware of this entity especially in regard to fishermen presenting to the Emergency Department with such a clinical presentation and its toxic manifestations. This incident also illustrates the need of enforcement of health and safety regulations in the fishing industry.

Situación epidemiológica de intoxicación por monóxido de carbono (CO) / Epidemiological situation of carbon monoxide intoxication (CO)

El monóxido de carbono es un gas tóxico, incoloro, inodoro e insípido que se produce durante la quema de combustible. Las intoxicaciones por monóxido de carbono (CO) constituyen causa de enfermedad y muerte. Además del evento agudo, los cuadros de intoxicación graves pueden dejar secuelas cognitivas. La exposición crónica también es importante dado que puede producir sintomatología neurológica y cognitiva. Se presentan diferentes análisis de la serie histórica que va desde 2005 a la Semana Epidemiológica 38 de 2016, de las intoxicaciones por Monóxido de Carbono asistidas en la Ciudad de Buenos Aires. Los datos para la construcción de indicadores del presente informe provienen del registro de casos individuales de intoxicación por CO, en el módulo C2 de Vigilancia Clínica del Sistema Nacional de Vigilancia de la Salud (SNVS)

Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote?

Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.

[Chemicals as fire damaging factor].

The article provides an overview of published scientific data about toxic chemical compounds formed during thermal degradation of various materials. In case of fire the complex of physical and chemical factors affect the human, along with injuries, thermal burns of the skin and respiratory tract there is a lack of oxygen in the inspired air and the impact of thermal degradation products. The greatest number of deaths in.a fire due to the inhalation by the victims smoke and toxic gases. The impact of the combination of toxic substances leads to the development of various forms of toxic process. The main causes of poisoning at the fires due to the effects of toxic substances and substances which can cause structural and functional disorders of the respiratory organ. Intoxication manifestations by some of them appear already in the fire zone, in other cases, in cases of poisoning by the compounds of the slow motion, there is the latent period of of intoxication. Knowledge of the spectrum of toxic products thermal destruction on the human during the fire, it is necessary to develop approaches to improve medical care and creation of tools of medical protection.

[Case of dyspnea due to toilet cleaner containing nitric acid for household use].

A 40-year-old male tried to clean a urinal at his home storing 900 mL of a toilet cleaner containing 9.8% nitric acid to remove calcium deposit, and clean the toilet floor for twenty minutes. Immediately after using the cleaner, he experienced eye irritation. He washed out the toilet cleaner. However, he thereafter experienced dyspnea, a compressive sensation in his chest, and chest and back pain about 40 minutes after the cleaning the toilet. He monitored his symptoms overnight and found them to gradually improve. However, the symptoms still remained the next morning and therefore he came to our department on foot. He had no particular past or family history. On arrival, his physiological findings and chest computed tomography scan were negative for any abnormalities. His arterial blood gas analysis revealed a mild abnormality of oxygenation. Observation without any drugs revealed that a complete remission of his symptoms occurred after approximately 4 weeks. Based on the results of the experiments, contact with the mucosal membrane and nitric acid gas produced by any accidentally coexisting metals or contact with moisture, including nitric acid produced by a reaction between CaCO3 and cleaner, may have been the mechanism of occurrence for the symptoms observed in this case. This is the first reported case of nitric acid poisoning due to the use of a toilet cleanser intended for household use.

What diagnostic tools are available to document death by H2S exposure?

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

Sarin exposure: a simulation case scenario.

Given the current geopolitical tensions, the risk of a terrorist attack on the United States is constant and increasing. Chemical terrorism, specifically the use of nerve agents, has occurred in other nations. Because of the ease of manufacture, the ability to conceal them, and the lethality of these agents, they pose a potential threat as a weapon of terror. Nerve agent exposure requires prompt recognition, a series of actions to mitigate further exposure to others, and management of the physiological sequelae of exposure. Many civilian healthcare providers are unprepared to manage injuries from nerve exposure. Failure to recognize the signs of nerve agent exposure will increase mortality and morbidity in victims and place healthcare providers at risk. Simulation is an effective methodology to train healthcare personnel in disaster preparedness. This article presents a simulation scenario that reviews the presentation of nerve agent exposure, its management, and a recipe for performing this simulation in a training exercise.

Metal fume fever - a case review of calls made to the Victorian Poisons Information Centre.

OBJECTIVE: To determine the epidemiology of metal fume fever over an extended period in Victoria, Australia. METHODS: A retrospective case review of all metal fume fever related calls to the Victorian Poisons Information Centre. Specific defined criteria were used to identify cases of metal fume fever and a set of data points extracted for each. RESULTS: Eighty-four (99%) of the cases involved adults. Fifty-three percent of exposures occurred in the workplace. The most frequent day of symptom manifestation was Monday (24%). All of the calls concerned people involved in welding metal with subsequent inhalation of fumes. DISCUSSION: Calls were most common at the beginning of the week, reflecting the previously described phenomena of increased symptoms occurring after a period on nonexposure (loss of tolerance). Workplace safety and education is key to prevention of metal fume fever. Medical profession education may help prevent occurrences of metal fume fever at home, at school and in the workplace.

Acute collective gas poisoning at work in a manure storage tank.

Cases of deaths in manure or septic tanks are rare in legal-medical practice, more frequently as unfortunate occupational accidents. Poisoning with toxic gases, especially with hydrogen sulfide, is reported as the cause of death, while the exhaustion of oxygen in the air is omitted with the simultaneous excess of carbon dioxide. In such cases, determination of the direct cause of death constitutes a big problem because post-mortem examination does not reveal the specific changes. A case of acute collective poisoning by gases in a manure storage tank is presented of 5 agricultural workers, 2 of whom died. While explaining the cause of poisoning and deaths, toxicological blood tests were performed in the victims of the accident, as well as gases inside the manure storage tank. The post-mortem examinations and toxicological blood tests performed did not allow determination of the direct cause of death. Toxicological tests of gases from inside the manure tank showed a very low concentration of oxygen, with a simultaneous very high concentration of carbon dioxide, and a considerable level of hydrogen sulfide. The cause of fainting of three and deaths of two workers was not the poisoning with hydrogen sulfide, but oxygen deficiency in the air of the tank.

[Inhalation injury--epidemiology, diagnosis and therapy]. / Das Inhalationstrauma - Epidemiologie, Diagnostik und Therapie.

OBJECTIVE: Inhalation injury is a vitally threatening medical syndrome, which might appear in patients with or without burn injuries. Thus, knowledge about development, diagnosis and treatment of inhalation injury should be available for each physician working in an intensive care unit. METHODS: This review starts with the causal and formal pathogenesis of inhalation injuries. Furthermore, diagnosis and treatment in the critical care setting are presented, followed by the discussion of possible complications. Specific intoxications such as carbon monoxide are due to their importance separately discussed. CONCLUSIONS: Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.

Metal fume fever: a review of the literature and cases reported to the Louisiana Poison Control Center.

Metal fume fever (MFF) is an important occupational-related illness resulting from inhalation of volatile metal oxides, especially zinc, that are produced during welding or cutting of metal materials. Onset of MFF is rapid, occurring within a few hours after inhalation of the fumes. Symptoms include fever, chills, cough, dyspnea, headache, myalgia, and malaise. Symptoms are self-limiting and typically resolve within 24 hours with a subsequent short-lived tolerance to zinc oxide fumes that disappears after one to two days of avoidance. In this report, we present an overview of MFF's history, pathogenesis, clinical presentation, regulatory guidelines, and prevention recommendations. This review is followed by a description of MFF cases reported by the Louisiana Poison Control Center to the Louisiana Office of Public Health's Section of Environmental Epidemiology and Toxicology during a two-year period.

Ocular and respiratory illness associated with an indoor swimming pool--Nebraska, 2006.

On December 26, 2006, the Nebraska Department of Health and Human Services (NDHHS) received a report of a child hospitalized in an intensive care unit for severe chemical epiglottitis and laryngotracheobronchitis after swimming in an indoor motel swimming pool. The pool was inspected the same day and immediately closed by NDHHS because of multiple state health code violations. NDHHS initiated an outbreak investigation to identify additional cases and the cause of the illness. This report describes the results of that investigation, which indicated that 24 persons became ill, and the outbreak likely was the result of exposure to toxic levels of chloramines that had accumulated in the air in the enclosed space above the swimming pool. This outbreak highlights the potential health risks from chemical exposure at improperly maintained pools and the need for properly trained pool operators to maintain water quality.

[Gas poisoning: respiratory irritants and axphyxiants]. / Otrovanja plinovima: respiracijski iritansi i asfiksansi.

Inhalation exposure to harmful substances in the working as well as in general environment may induce serious health effects. The severity of gas poisoning is determined primarily by its physical and chemical characteristics, and the level and duration of exposure. Toxic effects from gas inhalation involve simple asphyxia, respiratory irritation, systemic toxicity, and a combination of these mechanisms. This article describes the characteristics, types of exposure and health effects of most common irritant and asphyxiant gases, including carbon monoxide, hydrogen cyanide and ammonia.