Inhalation of gases resulting in global tissue hypoxia
Goal of Care
Decontamination if required. Airway management and oxygenation. Transfer to closest facility that can support patient.
Many toxic chemicals are water soluble; as such they have an affinity for the body’s areas of moisture. Toxic gasses known as irritants are classified based on their water solubility: as high, intermediate, and slight. Toxic gasses known as asphyxiants are chemicals that interfere with the body’s ability to transport or use oxygen, resulting in asphyxiation. Asphyxiants are classified as simple or systemic.
The duration of exposure, chemical toxicity, concentration, are the main factors that determine the toxic effects on the patient and their clinical outcome. The primary areas affected are the airways and respiration. Corrosive toxic effects occur topically from the oral-nasal cavities into the lower airways and down to the alveolar-capillary membrane. Asphyxiant effects occur within the body at the alveolar and cellular level.
Dermal (Skin & Mucous Membranes)
Chemicals that interfere with the body’s ability to transport or use oxygen resulting in asphyxiation. Asphyxiants Toxidrome is also known as the “Knockdown Toxidrome” because of its ability to have a patient collapse due to a sudden loss of consciousness.
Simple Asphyxiants are not toxic as a chemical but displace oxygen from the ambient air so less oxygen is inhaled. Carbon Dioxide and Nitrogen are simple asphyxiants.
Systemic Asphyxiants are toxic chemicals that interfere with hemoglobin’s oxygen delivery to the tissues (Carbon Monoxide) or block cellular oxygen metabolism
Responder safety, is patient decontaminated?
PPE for Blood, Body, Fluid (BBF) potential.
Skin and eye decontamination.
Airway management and oxygenation in the prevention of Hypoxemia/Asphyxia
Decontamination if required.
Airway management and oxygenation.
Transfer to closest facility that can support patient. In the lower mainland consider transporting to BCCH unless the patient is unstable.
Oxygen Therapy – All exposed patients
Hyperbaric chamber – CO exposure
Hydroxocobalamin - Cyanide poisoning antidote 70mg/kg IV as a single infusion; may repeat depending on the severity of poisoning and clinical response.