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New at Work Not all H2S comes from the ground or from the oilfield Some chemicals are fatal P bar Y Safety Consultants Alberta Canada Chemical Awareness, Research, Education, & Solutions for you workplace Toxicological Emergencies P bar Y Safety Consultants Alberta Canada 1 ABSENCE OF EVIDENCE IS NOT EVIDENCE OF ABSENCE P bar Y Safety Consultants Alberta Canada 27 Poisons • A poison is a substance that, on ingestion, inhalation, absorption, application, injection, or development within the body in relatively small amounts, may cause structural damage or functional disturbance P bar Y Safety Consultants Alberta Canada Poisonings • Poisonings may be unintentional or intentional – Most poisonings are unintentional (accidental) • Dosage errors • Idiosyncratic reactions • Environmental exposure • Occupational exposure P bar Y Safety Consultants Alberta Canada Poisonings • Intentional poisonings – Acts of terrorism – Suicide (self-poisoning) – Homicide (murder) P bar Y Safety Consultants Alberta Canada Chemical poisons in household cleaning products and personal care products are affecting you and your children. POISON CONTROL CENTER Cases of exposures annually: Cleaning substances – more than 217,400 Cosmetics (PC) – more than 205,200 Pesticides – more than 78,500 Hydrocarbons – more than 62,000 P bar Y Safety Consultants Alberta Canada 2 Solid Poisons • Poisons can be found in four forms: solid, liquid, spray, or gas – Solid poisons include medicines, plants, powders – Examples: • Laundry detergent • Automatic dishwasher detergent • Granular pesticides • Fertilizers P bar Y Safety Consultants Alberta Canada Poisons • Liquid poisons • Poisons in spray form – Lotions – Insecticides – Liquid laundry soap – Spray paint – Furniture polish – Some cleaning products – Lighter fluid – Syrup medicines P bar Y Safety Consultants Alberta Canada Poisons • Gases or vapors that are poisonous (invisible poisons) include: – Carbon monoxide from hot water heaters and furnaces – Exhaust fumes from automobiles – Fumes from gas or oil burning stoves P bar Y Safety Consultants Alberta Canada CONSTANT AND REPEATED EXPOSURE During one day, we expose ourselves to more than 200 different chemicals Perfume Sunscreen Cosmetics Bubble Bath Hand Lotion Baby Products Shampoo Dish Detergent Toothpaste Bathroom Cleaner Shaving Cream Air Freshener Deodorant Carpet Cleaner Mouthwash Dryer Sheets P bar Y Safety Consultants Alberta Canada 12 Scene Safety • Perform a scene size-up • Ensure scene safety before proceeding with patient assessment P bar Y Safety Consultants Alberta Canada • A 14-year-old Japanese girl killed herself in her bathroom by mixing laundry detergent with liquid cleanser, releasing fumes that sickened 90 people in her apartment house. • The door was closed, and she had affixed a sign on the outside warning, "Gas being emitted.” • None of the sickened neighbors in Konan, southern Japan, were severely ill, although about 10 were hospitalized. • The deadly hydrogen sulfide gas escaped from the girl's bathroom window and entered neighboring apartments. • The girl's suicide was part of an expanding string of similar deaths that experts say have been encouraged by Internet suicide sites since last summer. P bar Y Safety Consultants Alberta Canada Common household chemicals have been linked to allergies, birth defects, cancer, and psychological abnormalities…. Of 17,000 household product chemicals, very few have been tested for toxicity. More testing is needed on their effects, AND the results of combining multiple chemicals in a product. Ingredients often interact to magnify harmful effects in humans, animals, and the environment. P bar Y Safety Consultants Alberta Canada 35 Death • A 31-year-old man outside Tokyo killed himself inside a car by mixing detergent and bath salts. P bar Y Safety Consultants Alberta Canada Reports of another similar death emerged when the body of a 42-year-old woman in Nagoya, central Japan, was found in a bathtub. According to Kyodo, there was toilet cleaner and bath powder nearby, along with a sign outside that read, "Poisonous gas being emitted. Caution.“ Nagoya police said they could not comment on the case, but Kyodo said that fire officials called to the scene did not detect hydrogen sulfide gas. The method has alarmed officials because of the danger that bystanders can be hurt. P bar Y Safety Consultants Alberta Canada Examples of chemical suicides • In Arizona one individual manufactured hydrogen cyanide instead of hydrogen sulfide. • It may be rare because chemicals needed for the reaction are not as readily available as those used to make hydrogen sulfide. P bar Y Safety Consultants Alberta Canada HOUSEHOLD PRODUCTS CHEMICALS IMPLICATED IMPLICATED IN THE IN THE EXPOSURES EXPOSURES Methylene Chloride All purpose cleaners Toluene Drain Cleaners Formaldehyde/formalin Dishwashing detergents Glycol: Ethylene Laundry soaps Glycol: Other Laundry Additives Acetone Bleaches Ammonia Carpet/upholstery cleaners Borates/Boric Acid Glass Cleaners Chlorates Fabric Softeners Dioxins Disinfectants (cleaning) Nitrates/nitrites Air Deodorizers Alkali Fabric Deodorizers Acids P bar Y Safety Consultants Alberta Canada 36 HOW does your home become so toxic? HOUSEHOLD JUST SOME OF THE CLEANING PRODUCTS CHEMICALS IN HOUSEHOLD CLEANING PRODUCTS AND PERSONAL CARE Methylene Chloride PRODUCTS Ethylene glycol Toluene / Xylene Pentachlorophenol RELEASE TOXIC Dichlorobenzene VAPORS INTO Chlorofluoromethane THE AIR WHEN Phenylphenol Formaldehyde THEY ARE USED – AND EVEN WHEN THEY ARE STORED. This process is called outgassing. P bar Y Safety Consultants Alberta Canada 37 THE THREE MOST REPORTED POISONING CATEGORIES P bar Y Safety Consultants Alberta Canada 16 SKIN absorbs far more than you think – it’s like a sponge! P bar Y Safety Consultants Alberta Canada 15 Substances get into your body three ways: INGESTION INHALATION ABSORPTION P bar Y Safety Consultants Alberta Canada 13 UP TO 4,000 separate ingredients, most of them synthetic Toluene Methylene chloride Benzene Formaldehyde P bar Y Safety Consultants Alberta Canada 21 Some by accident others on purpose P bar Y Safety Consultants Alberta Canada Responding to chemical suicides • Interview anyone who may have approached the scene to learn what they saw or smelled. • A “rotten egg” smell would indicate hydrogen sulfide. • An almond odor is typical of cyanide compounds. P bar Y Safety Consultants Alberta Canada Responding to chemical suicides • Look for indications a chemical reaction has been initiated. • Typically you will find containers of household chemicals and pails, buckets, pots or other containers where the chemicals have been mixed. • Improvised “containers”, such as a sink or the glove box of an automobile, could be used to mix the chemicals. P bar Y Safety Consultants Alberta Canada Responding to chemical suicides • Air sampling equipment can be used to determine the presence or absence of hydrogen sulfide or hydrogen cyanide. • A small hole may be punched in a car or home window, or a probe, or colorimetric tube inserted in the gap between a door to the room and the floor. • A hydrocyanic acid tube will detect hydrogen cyanide. • Hydrogen sulfide is heavier than air, but hydrogen cyanide is slightly lighter. P bar Y Safety Consultants Alberta Canada Responding to chemical suicides • If the vapor in the space cannot be identified, or the presence of hydrogen cyanide is confirmed entry should only be made by individuals protected by fully encapsulated chemical protective clothing (level A). • Hydrogen cyanide is immediately dangerous to life and health at concentrations above 50 parts per million. P bar Y Safety Consultants Alberta Canada Responding to chemical suicides Both hydrogen sulfide and hydrogen cyanide are flammable. The Lower Explosive Level of hydrogen sulfide is 4% and the LEL of hydrogen cyanide is 5.6%. There have been no incidents of fire reported with these incidents. It is believed that concentrations do not typically reach the LEL except at close proximity to the mixing container. Responders should eliminate ignition sources whenever possible. P bar Y Safety Consultants Alberta Canada Responding to chemical suicides • Vapors inside the space should be ventilated to the outside. • Ensure no one will be endangered by the vapors before using natural or forced ventilation to air the space out. • Anyone who has been exposed to the vapors should be decontaminated with soap and water. P bar Y Safety Consultants Alberta Canada Paradichlorobenzene poisoning Some vacuum cleaners have an attachment for killing bugs. The attachment holds moth crystals (Paradichlorobenzene, pronounced “para-di- chloro-benzene”) This attachment will convert your vacuum sweeper to exterminate insects (spiders, roaches, ants, etc.). Anything that can walk or crawl. P bar Y Safety Consultants Alberta Canada What do the instructions say? One vacuum instruction book says: How to use the crystalator: Warning: Follow directions and cautions on label of crystal container. Keep crystals out of reach of children. Crystals may be harmful if taken internally. Do not breathe the concentrated gas from the crystalator. Do not enter a treated closet until it has ventilated. Do not remain in a treated room until gas concentration is reduced to safe level. If eye, throat, or skin irritation occurs, do not remain in treated area. Return unused crystals to closed container and seal tight. In the crystalator, P bar Y Safety Consultants Alberta Canada Paradichlorobenzene poisoning • Paradichlorobenzene is a white, solid chemical with a very strong odor. • Poisoning can occur if you swallow this chemical or inhale it in a gaseous form. • Where Found - Toilet bowl deodorizers and Moth repellant. (not all-inclusive). P bar Y Safety Consultants Alberta Canada Paradichlorobenzene poisoning Symptoms: – Burning in mouth – Breathing problems (rapid, slow, or painful) – Cough – Shallow breathing – Changes in alertness – Headache – Slurred speech – Weakness – Yellow skin (jaundice) – Abdominal pain – Diarrhea – Nausea – Vomiting P bar Y Safety Consultants Alberta Canada WORKPLACE PROHIBITED CHEMICALS BIOTHIONOL MERCURY COMPOUNDS VINYL CHLORIDE HALOGENATED SALICYANILIDES ZIRCONIUM COMPLEXES (in aerosols) CHLOROFORM METHYLENE CHLORIDE CHLOROFLUOROCARBON (in aerosols) HEXACHLOROPHENE METHYL METHACRYLATE MONOMER (in nail products) P bar Y Safety Consultants Alberta Canada 5 Anticholinergic Signs/ Agitation or reduced responsiveness, Symptoms tachypnea, tachycardia, slightly elevated temperature, blurred vision, dilated pupils, urinary retention, decreased bowel sounds; dry, flushed skin Typical Agents Atropine, diphenhydramine, scopolamine Primary Antidote Physostigmine P bar Y Safety Consultants Alberta Canada Cholinergic Signs/ Altered mental status, tachypnea, Symptoms bronchospasm, bradycardia or tachycardia, salivation, constricted pupils, polyuria, defecation, emesis, fever, lacrimation, seizures, diaphoresis Typical Organophosphate insecticides (malathion), Agents carbamate insecticides (carbaryl), some mushrooms, nerve agents Primary Antidote Atropine P bar Y Safety Consultants Alberta Canada Opioid Signs/ Altered mental status, bradypnea or apnea, Symptoms bradycardia, hypotension, pinpoint pupils, hypothermia Typical Codeine, fentanyl, heroin, meperidine, Agents methadone, oxycodone, dextromethorphan, propoxyphene Primary Naloxone Antidote P bar Y Safety Consultants Alberta Canada Anticholinergic Syndrome • Mad as a hatter – confused delirium • Red as a beet – flushed skin • Dry as a bone – dry mouth • Hot as Hades – hyperthermia P bar Y Safety Consultants • Blind as a bat – dilated pupils Alberta Canada Cholinergic Syndrome • “SLUDGE” • “DUMBELS” – Salivation – Diarrhea – Lacrimation – Urination – Urination – Miosis (pinpoint – Defecation pupils) – Gastrointestinal – Bronchospasm/ distress Bronchorrhea/ – Emesis Bradycardia – Emesis – Lacrimation – Salivation P bar Y Safety Consultants Alberta Canada Odors and Toxins Odor Toxin Acetone Acetone, isopropyl alcohol, salicylates Alcohol Ethanol, isopropyl alcohol Bitter almonds Cyanide Carrots Water hemlock Fishy Zinc or aluminum phosphide Fruity Isopropyl alcohol, chlorinated hydrocarbons (e.g., chloroform) Garlic Arsenic, organophosphates, DMSO, phosphorus, thallium Glue Toluene Mothballs Camphor Pears Chloral hydrate, paraldehyde Rotten eggs Sulfur dioxide, hydrogen sulfide Shoe polish Nitrobenzene Vinyl Ethchlorvynol Wintergreen Methyl salicylates P bar Y Safety Consultants Alberta Canada General Management Guidelines • Frequently monitor vital signs and ECG • Safely obtain any substance or substance container of a suspected poison and transport it with the patient P bar Y Safety Consultants Alberta Canada Decontamination • Decontamination methods used depend on the toxin and type of exposure P bar Y Safety Consultants Alberta Canada Decontamination – Skin • Don appropriate personal protective equipment (PPE) – May include specific clothing and respiratory gear • Remove child’s clothing and place it in plastic bags • Flood exposed areas of the skin with water to remove residual material from the skin – Avoid contaminating uninvolved areas • Wash exposed areas with soap and water for P bar Y Safety Consultants 10 to 15 min with gentle sponging Alberta Canada CAUSTICS (ACIDS, ALKALIS) P bar Y Safety Consultants Alberta Canada Caustics (Acids, Alkalis) Description Alkaline agents cause deep penetration injury; tissue destruction continues until substance is significantly neutralized or concentration is greatly reduced Common alkaline products: bleach, ammonia, dishwasher detergent, laundry detergent, drain and oven cleaners Acids cause an immediate superficial injury; injury may continue to evolve for up to 90 min after the ingestion Common acid products: sulfuric, hydrochloric, or hydrofluoric acid P bar Y Safety Consultants Alberta Canada Caustics (Acids, Alkalis) Signs/ Severe burns to the stomach or esophagus Symptoms may be present with little external evidence of the severity of the injury Upper airway obstruction with difficulty breathing, speaking, or swallowing; GI hemorrhage, esophageal or gastric perforation Vomiting, stridor, drooling – if 2 of these 3 symptoms are present, likelihood of GI burns is high (vomiting powerful predictor of severe esophageal injury) P bar Y Safety Consultants Alberta Canada Caustics (Acids, Alkalis) Interventions Protective equipment, ABCs, O2, IV Priority = airway management Flexible fiberoptic intubation over an endoscope is preferable to standard orotracheal intubation Emergent cricothyrotomy may be necessary Do NOT induce vomiting Activated charcoal contraindicated Controversy exists regarding whether or not attempts should be made to neutralize the caustic substance with water or milk If a history of significant ingestion with oral lesions or if child is otherwise symptomatic, perform endoscopy to determine extent of injury P bar Y Safety Consultants Alberta Canada ETHYLENE GLYCOL (ANTIFREEZE) METHANOL (METHYL ALCOHOL, WOOD ALCOHOL) P bar Y Safety Consultants Alberta Canada Ethylene Glycol, Methanol Description Ethylene glycol ingestion leads to profound metabolic acidosis and coma; as little as 5 mL may be toxic to an infant Methanol, found in window-washer fluid or gas-line antifreeze, is metabolized to formic acid, with the same effect as ethylene glycol; as little as 15 mL may be toxic to an infant P bar Y Safety Consultants Alberta Canada Ethylene Glycol, Methanol Signs/ Altered mental status with appearance of Symptoms inebriation or reduced responsiveness, or coma Tachypnea, tachycardia, nausea and emesis; abdominal pain, muscle incoordination, seizures Blurred vision possible with methanol P bar Y Safety Consultants Alberta Canada Ethylene Glycol, Methanol Interventions ABCs, O2, IV Administer glucose if hypoglycemia present Fomepizole antidote for methanol and ethylene glycol poisoning, indications for use are levels ≥20 mg/dL or high anion gap metabolic acidosis Ethanol may be used when fomepizole is not available Consider hemodialysis in severe cases Methanol level, glucose P bar Y Safety Consultants Alberta Canada HYDROCARBONS (PETROLEUM DISTILLATES) P bar Y Safety Consultants Alberta Canada Hydrocarbons Description Toxic dose varies depending on agent involved and whether it was aspirated, ingested, or inhaled Common products: Lamp oil Gasoline Lighter fluid Kerosene Furniture polish Turpentine Pine oil Phenol P bar Y Safety Consultants Alberta Canada Hydrocarbons Signs/ Coughing and choking on initial ingestion; Symptoms gradual increase in work of breathing Odor of hydrocarbon on breath Dry, persistent cough; crackles, wheezes, diminished breath sounds, tachypnea Nausea/vomiting, dizziness, altered mental status, dysrhythmias possible May cause skin surface burns P bar Y Safety Consultants Alberta Canada Hydrocarbons Interventions Protective equipment, remove contaminated clothing and wash skin with soap and water ABCs, O2, assist ventilations as necessary, anticipate need for intubation Activated charcoal contraindicated Consult Poison Control P bar Y Safety Consultants Alberta Canada An excerpt from the MSDS for an ingredient in many brand name toothpastes…. SODIUM HYDROXIDE MSDS Number: S4034 Effective Date: 08/20/98 3. Hazards Identification Emergency Overview -------------------------- POISON! DANGER! CORROSIVE. MAY BE FATAL IF SWALLOWED. HARMFUL IF INHALED. CAUSES BURNS TO ANY AREA OF CONTACT. REACTS WITH WATER, ACIDS AND OTHER MATERIALS. Health Rating: 3 - Severe (Poison) P bar Y Safety Consultants Alberta Canada 31 “Not a single child today is born free of synthetic chemicals” “There is a lot we don’t know about chemicals. What we do know is that: • breast cancer rose steadily over the last four decades • over 40,000 women will die of it this year. Brain cancer in children is up by 26% • testicular cancer in older teenage boys has doubled • infertility in young adults is up, and so are learning disabilities in young children… P bar Y Safety Consultants Alberta Canada 9 PLEASE NOTE AND TAKE HEED! Responding to chemical suicides •Look for indications a chemical reaction has been initiated. •Typically you will find containers of household chemicals and pails, buckets, pots or other containers where the chemicals have been mixed. •Improvised “containers”, such as a sink or the glove box of an automobile, could be used to mix the chemicals. P bar Y Safety Consultants Alberta Canada Time for Questions P bar Y Safety Consultants Alberta Canada
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