What to do in case of inhalation of harsh chemicals?

Immediate Management of Harsh Chemical Inhalation

Remove the victim from the toxic environment immediately, ensure scene safety for rescuers, assess and secure the airway, administer 100% high-flow oxygen, and activate emergency medical services while monitoring for respiratory distress. 1, 2

Scene Safety and Initial Response

Rescuer safety must be the first priority—never place yourself at greater risk than the victim. 1

• Rapidly assess environmental hazards including toxic fumes and gas before approaching the victim 1
• Wear appropriate protective equipment including gas masks and butyl rubber gloves when dealing with toxic vapors, as ordinary surgical masks and latex gloves provide inadequate protection 1
• Remove the victim from the contaminated area to fresh air immediately 2
• Be aware that secondary contamination can occur from the victim's clothing and exhaled air, potentially affecting healthcare workers 1

Immediate Victim Assessment and Airway Management

Assess the airway, breathing, and circulation following standard life support protocols. 1, 2

• Open the airway by lifting the chin and tilting the head 1
• Check for breathing by looking, listening, and feeling 1
• Remove any visible obstruction from the mouth 1
• If assisted ventilation is required (particularly with hydrogen cyanide or hydrogen sulfide exposure), use only a mask with a non-return valve system to prevent rescuer exposure to exhaled air 1
• Consider early intubation if upper airway obstruction is suspected from thermal damage or edema 3

Oxygen Administration

Administer 100% oxygen immediately to all victims of chemical inhalation. 1, 3

• All fire or chemical exposure victims should be presumed to have carbon monoxide intoxication and treated with 100% oxygen until carboxyhemoglobin levels normalize 3
• High inspired oxygen concentration is indicated for hydrogen cyanide poisoning, which impairs cellular oxygen usage 1
• Continue oxygen therapy while monitoring for respiratory distress 2

Decontamination Procedures

Remove all contaminated clothing immediately to prevent continued exposure and secondary contamination. 1, 4

• Remove the victim's clothing, shoes, and jewelry to prevent chemicals from being trapped against the skin 4
• Handle contaminated clothing and body fluids (especially vomit) with extreme caution using proper protective equipment 1
• If skin contact has occurred with corrosive chemicals, immediately irrigate affected areas with copious amounts of water for at least 15 minutes 1, 4
• For eye exposure to toxic substances, rinse immediately with copious amounts of water for at least 15 minutes 1

Monitoring and Emergency Activation

Activate emergency medical services immediately if the victim exhibits any life-threatening signs. 1

• Call EMS for difficulty breathing, seizures, altered consciousness, or severe respiratory distress 1, 2
• Monitor for signs of respiratory failure including dyspnea, wheezing, chest tightness, and hypoxemia 3
• Watch for delayed pulmonary edema, which can develop hours after exposure (particularly with phosgene) 5
• Contact poison control centers (1-800-222-1222 in the US) for specific guidance on identified chemical agents 1

Specific Chemical Considerations

Different chemicals require specific management approaches beyond general supportive care. 1, 5

• Hydrogen cyanide: Look for hyperventilation and tachycardia progressing to coma, cyanosis, and convulsions; antidotes (hydroxocobalamin or sodium thiosulfate) should be administered on confirmation 1
• Organophosphorus compounds: These are easily absorbed through skin and respiratory tract, requiring aggressive decontamination and specific antidotal therapy 1
• Chlorine, phosgene, hydrogen sulfide, ammonia: These cause immediate reactions with mucous membranes and require early airway management and lung-protective strategies 5

Critical Pitfalls to Avoid

• Do not delay removal from the toxic environment to begin treatment—get the victim to fresh air first 1, 2
• Do not administer anything by mouth unless specifically advised by poison control or emergency medical personnel, as this may be harmful 1
• Do not perform mouth-to-mouth ventilation without barrier protection in cases of toxic gas exposure due to risk of secondary contamination 1
• Fixed dilated pupils should not preclude resuscitation in cyanide poisoning, as high success rates have been reported 1

Ongoing Management

Provide supportive care and monitor for delayed complications. 2, 5

• Implement lung-protective ventilator strategies if mechanical ventilation becomes necessary 5
• Provide aggressive pulmonary toilet and avoid volume overload 5
• Monitor for development of acute respiratory distress syndrome, which may be delayed up to 24 hours with certain exposures 5
• Observe for long-term sequelae including bronchial hyperreactivity, chronic airflow obstruction, or reactive airways dysfunction syndrome 6