What to do in case of accidental chlorine gas inhalation?

Emergency Management of Chlorine Gas Inhalation

In case of accidental chlorine gas inhalation, immediately remove the victim from the exposure area, move to fresh air, and administer 100% humidified oxygen while seeking emergency medical attention. 1, 2

Immediate Actions

• Remove the victim from the exposure area to prevent further inhalation of chlorine gas 1
• Remove all contaminated clothing and jewelry to prevent continued exposure 3
• Move to fresh air and administer 100% humidified oxygen immediately 2, 4
• Call emergency services or poison control center for guidance while initiating treatment 3
• Avoid taking public transportation to the hospital; use an ambulance or private vehicle with windows open for ventilation 5

Medical Management Based on Severity

Mild Exposure (can be discharged within 6 hours)

• Symptoms: cough, nausea, vomiting, conjunctival hyperemia 1
• Treatment:
  • Humidified oxygen therapy 1
  • Symptomatic treatment is usually sufficient 1
  • Monitor for at least 4-6 hours before discharge 1

Moderate Exposure (requires 24-hour observation)

• Symptoms: mild exposure symptoms plus dyspnea 1
• Treatment:
  • Humidified oxygen therapy 1, 2
  • Bronchodilators for bronchospasm 2
  • Corticosteroids (intravenous or inhaled) 1, 2
  • Consider nebulized sodium bicarbonate solution (may help neutralize hydrochloric acid formed when chlorine reacts with water in lungs) 4

Severe Exposure (requires hospitalization)

• Symptoms: moderate exposure symptoms plus palpitations, weakness, chest tightness 1
• Treatment:
  • Aggressive respiratory support, including possible intubation for respiratory failure 2
  • Bronchodilators and intravenous corticosteroids 2
  • Consider inhaled epoprostenol for severe cases 2
  • Standard ARDS management protocols including prone positioning if ARDS develops 2
  • Fiberoptic bronchoscopy may be considered to evaluate bronchial damage and alveolar hemorrhage 6

Special Considerations

• Oxygen should be used with caution in massive chlorine exposure as it may worsen respiratory acidosis despite improving survival; early assessment for assisted ventilation is crucial 7
• For eye exposure, flush eyes immediately with copious amounts of tepid water for at least 15 minutes 3
• Chemical conjunctivitis may require specialized ophthalmologic care 2
• Patients with pre-existing respiratory conditions may experience more severe symptoms and require more aggressive management 1

Follow-up Care

• All patients with significant exposure should have clinical follow-up to assess for delayed respiratory complications 1
• Patients with severe exposure should undergo pulmonary function testing to evaluate for long-term effects 6
• Monitor for development of reactive airways dysfunction syndrome (RADS), which may develop after a single high-level exposure 2

Common Pitfalls

• Failing to recognize that symptoms may be delayed for several hours after exposure 2
• Not providing adequate respiratory support early in severe cases 2
• Discharging patients too early before delayed symptoms develop 1
• Not considering nebulized sodium bicarbonate as a potential treatment option, especially in pediatric patients 4