INTLIFE PAIN MANAGEMENT CIC – FIRST CONSULTATION FORM REGISTRATION NUMBER: . . . . . . . . . . . . . . . . . . . . . . . FIRST NAME: . . . . . . . . . . . . . . . . . . . . . . . . SURNAME: . . . . . . . . . . . . . . . . . . . . . . (IF APPLICABLE) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Treatment overview:Antidote and Emergency Treatment - Sulfuryl Fluoride
Treatment Overview Sulfuryl Fluoride:
INHALATION - Remove victims of inhalation exposure from the toxic environment and administer 100 percent supplemental humidified oxygen with assisted ventilation as required. Rescuers should not enter areas with suspected high air concentrations without self-contained breathing apparatus. TOPICAL - Rewarming and a variety of topical treatments have been recommended for INHALATION EXPOSURE
INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with beta2 agonist and corticosteroid aerosols. Endotracheal intubation, supplemental oxygenation, and assisted ventilation may be required. Calcium replacement therapy may be needed. PULMONARY EDEMA (NONCARDIOGENIC): Maintain ventilation and oxygenation and evaluate with frequent arterial blood gas or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed. SEIZURES: Administer a benzodiazepine IV; DIAZEPAM (ADULT: 5 to 10 mg, repeat every 10 to 15 min as needed. CHILD: 0.2 to 0.5 mg/kg, repeat every 5 min as needed) or LORAZEPAM (ADULT: 4 to 8 mg; CHILD: 0.05 to 0.1 mg/kg). 1) Consider phenobarbital if seizures recur after diazepam 30 mg (adults) or 10 mg 2) Monitor for hypotension, dysrhythmias, respiratory depression, and need for Evaluate for hypoglycemia, electrolyte disturbances, hypoxia. Carefully observe patients with inhalation exposure for the development of any systemic signs or symptoms and administer symptomatic treatment as necessary. TORSADE DE POINTES: Hemodynamically unstable patients require electrical cardioversion. Treat stable patients with magnesium, isoproterenol, and/or atrial overdrive pacing. Correct electrolyte abnormalities (hypomagnesemia, hypokalemia, hypocalcemia). 1) MAGNESIUM SULFATE/DOSE: ADULTS: 2 g IV over 1 to 2 min, repeat 2 g bolus and begin infusion of 3 to 20 mg/min if dysrhythmias recur. CHILDREN: 25 to 50mg/kg diluted to 10 mg/mL; infuse IV over 5 to 15 min. 2) ISOPROTERENOL/DOSE: Correct hypovolemia first. ADULT: 2 to 10 mcg/minute (CHILD: 0.1 to 1 mcg/kg/minute) IV infusion; titrate to heart rate and rhythm response. Mix 1 mg isoproterenol HCl in 500 mL D5W for a 2 mcg/mL solution. 3) OVERDRIVE PACING: Begin at 130 to 150 beats per min, decrease as tolerated. 4) Avoid class Ia (quinidine, disopyramide, procainamide,aprindine) and most class III antiarrhythmics (N-acetylprocainamide, sotalol). EYE EXPOSURE
DECONTAMINATION: Irrigate exposed eyes with copious amounts of tepid water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist, the patient should be seen in a health care facility.
Rewarming and a variety of topical treatments have been recommended for treating Range of Toxicity:
Two fatalities occurred in a couple who lived in an 80,000 cubic foot house fumigated with 250
pounds of sulfuryl fluoride. Following fumigation, no one should enter the area without a self-
contained breathing apparatus until measured air concentrations are below 5 ppm.
[Rumack BH: POISINDEX(R) Information System. Micromedex, Inc., Englewood, CO, 2001; CCIS Volume 110, edition exp November, 2001. Hal AH & Rumack BH (Eds):TOMES(R) Information System. Micromedex, Inc., Englewood, CO, 2001; CCIS Volume 110, edition exp November, 2001.] **PEER REVIEWED** For immediate first aid: Ensure that adequate decontamination has been carried out. If victim is not breathing, start artificial respiration, preferably with a demand-valve resuscitator, bag-valve-mask device, or pocket mask as trained. Perform CPR if necessary. Immediately flush contaminated eyes with gently flowing water. Do not induce vomiting. If vomiting occurs, lean patient forward or place on left side (head-down position, if possible) to maintain an open airway and prevent aspiration. Keep victim quiet and maintain normal body temperature. Obtain [Bronstein, A.C., P.L. Currance; Emergency Care for Hazardous Materials Exposure. 2nd ed. St. Louis, MO. Mosby Lifeline. 1994. 416]**PEER REVIEWED** For basic treatment: Establish a patent airway. Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if necessary. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary . Monitor for shock and treat if necessary . Anticipate seizures and treat if necessary . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with normal saline during transport . Do not use emetics. For ingestion, rinse mouth and administer 5 mL/kg up to 200 mL of water for dilution if the patient can swal ow, has a strong gag reflex, and does not drool. . Cover skin burns with sterile dressings after decontamination [Bronstein, A.C., P.L. Currance; Emergency Care for Hazardous Materials Exposure. 2nd ed. St. Louis, MO. Mosby Lifeline. 1994. 416]**PEER REVIEWED** Treatment /of acute poisoning/ includes the iv admin of glucose in saline and gastric lavage with lime water (0.15% calcium hydroxide soln) or other Ca+2 salts to precipitate the fluoride. Calcium gluconate is given iv for tetany; urine volume is kept high with vigorous fluid resuscitation.
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