Transcript Slide 1

MANAGEMENT OF
EXPOSURE TO
HYDROGEN FLOURIDE
OR HF
PRESENTED BY:
Miguel Trevino, M.D.
Occupational Medicine
U.de M - U.C.S.C - FACOEM
MRO
GENERAL INFORMATION
ABOUT HF
USES OF HF
ELECTRONICS.- Production of microchips,
electronic circuit cleaners.
METALURGY.- Metal pickling/Aluminum
manufacture
PETRO CHEMICALS.- As a catalyst in the
alkalization of gasoline.
GLASS INDUSTRY. Glass edging.
REFRIGERENT GASES.- For automotive, air
conditioning, refrigerator home/industry.
FIRE EXTINGUISHERS.- Fluorocarbons.
USES OF HF
FLUOROCHEMICALS.- Fluorinated Salts
Production.
ANTIADHERENTS.- Production of Teflon.
MEDICINE.- Propellants for medication,
anesthetic gases, antibiotic production,
production and finishes of surgical prosthesis.
NUCLEAR INDUSTRY.- Purification of
uranium ore.
AGROCHEMICALS. Pesticides.
CLEANING SOLUTIONS. Rust removers.
PHYSICAL CHEMICAL
PROPERTIES
FREEZING POINT
-118ºF
VAPOR DENSITY
SPECIFIC GRAVITY
VAPOR PRESSURE
3.0 AT
25ºC
(2514) 0.97
AT 20ºC 775MM Hg
• BOILING POINT
• VOLATILITY
• SOLUBILITY IN WATER
ODOR
PHYSICAL STATE
DISSOCIATION
67ºF
100%
-83ºC
19ºC
100%
PUNGENT & IRRITATING
GAS
K=3.5 x 10-4
PHYSIOPATHOLOGY OF
EXPOSURES
&
KNOWN TOXICOLOGY
HF
TISSUE

//////////////////
H
+
F-
ENTRY ROUTES
SKIN
RESPIRATORY TRACT
EYES
GASTRO-INTESTINAL
TYPES OF EXPOSURE
LIQUID EXPOSURE (SPLASH BURN).
GAS EXPOSURE (INHALATION, SKIN &
EYES).
LIQUID & GAS (MIXED EXPOSURE).
LOW CONCENTRATION HF SOLUTIONS.
Once ionized, the fluoride creates two
types of salts:
INSOLUBLE SALTS
Fˉ + Ca (++ ) = Ca F(2)
Calcium Fluoride
Fˉ + Mg(++ ) = Mg F
Magnesium Fluoride
This can lead to Hypoglycemia that in turn
can lead to Cardio Respiratory Arrest,
Hypomagnesaemia, Na (Sodium) and K
(Potassium) alterations.
SOLUBLE SALTS
Fˉ + Na(+) = Na F
Sodium Fluoride
Fˉ + K(+) = KF
Potassium Fluoride
Which target:
The Kidneys – Nefro - Toxic
The Liver
– Liver - Toxic
And are the cause of Acute Fluoride
Intoxication if sufficient quantities are
created.
SO, WHY IS HF A HAZARDOUS
MATERIAL?
 It is a Corrosive. (Acid)
 It is a Poison. (Toxic)
 It is an Inhalation Hazard.
INTRINSIC PROCESS RISK FACTORS IN
RELATION TO HF
CHEMICAL
FACTORS
PHOSGENE
CYLINDERS
200
HCN
RAILROAD TANK
10
H2S
PRESSURIZED TANK
10
C12
RAILROAD TANK
9
SO2
IN CYLINDER
8
AHC1
ROAD TANK
2.5
AHF
IN A RAILROAD TANKER
1
Br2
PRESSURIZED TANK
0.80
SO3
PRESSURIZED TANK
0.60
NH3
NORMAL ATM CONDITIONS
0.30
OLEU
PRESSURIZED TANK
0.20
NH3
AT 33ºC
0.09
MMA
TANK
0.05
Br2
NORMAL ATM CONDITIONS
0.05
POC13
PRESSURIZED TANK
0.04
RISK FACTORS IN RELATION TO HF WHEN HF =
1.0
KNOWN TOXICOLOGY
Acute
Corrosive Effects (Burns)
Acute Fluoride Intoxication
Sub-Acute Impaired Breathing (hours after)
Delayed appearance of skin injury (hours after)
Chronic or Long Term
Injury to tissue due to corrosive and toxic effects.
No other effects documented or reported.
Possible Fluorosis after chronic exposure to low
concentrations of HF.
KNOWN TOXICOLOGY
 Reproductive & Developmental
None described or found
Immuno-Toxicity
None described or found
Cancer Forming
No human reports or studies
Cardiac & Muscular Toxicity
Yes, due to Fluoride binding to Calcium,
and Magnesium.
KNOWN TOXICOLOGY
Hepatic & Nefro Toxicity
Yes, due to creation of Sodium
Fluoride and Potassium Fluoride
after exposure (untreated).
KNOWN TOXICOLOGY
TWA
Time weighted average concentration for
a normal 8 hour workday and a 40 hour work
week to which nearly all workers may be
repeatedly exposed, day after day, without
adverse effects for all of their working life
3PPM (ACGIH).
KNOWN TOXICOLOGY
IDLH = 30 ppm
Immediately dangerous to life and health
(NIOSH).
KNOWN TOXICOLOGY
ERPG 1 = 5 ppm
The maximum airborne concentration
below which it is believed that nearly all
individuals could be exposed for up to 1 hour
without experiencing other than mild, transient
adverse health effects or without perceiving a
clearly defined objectionable odor.
KNOWN TOXICOLOGY
ERPG 2 = 20 ppm
The maximum airborne concentration
below which it is believed that nearly all
individuals could be exposed for up to 1 hour
without experiencing or developing irreversible
or other serious health effects or symptoms
which could impair an individual’s ability to take
protective action.
KNOWN TOXICOLOGY
ERPG 3 = 50 ppm
The maximum airborne concentration
below which it is believed that nearly all
individuals could be exposed for up to an hour
without experiencing or developing lifethreatening health effects.
PRIMARY
DECONTAMINATION
PROCEDURES
DECONTAMINATION PROCEDURES
 GO TO THE NEAREST FUNCTIONAL DECON UNIT.
 OPEN THE WATER VALVE.
 TAKE OFF ALL CLOTHING, SHOES & JEWELRY.
 REMOVE GOGGLES LAST, FACE THE WATER
FLOW, CLOSE YOUR EYES, PULL GOGGLES
OVER YOUR HEAD.
 REMEMBER, MAXIMUM TIME UNDER SHOWER IS
5 MINUTES.
This is a Dilution Technique.
TRIAGE
PRIMARY TRIAGE
1ST To Go
Many Signs & Symptoms of Exposure
2nd To Go
Signs and Symptoms Present and
Possible Systematic Effects in Near
Future
3rd To Go
Minor or No Signs & Symptoms
Do Not Go
Fatalities
SUGGESTED TREATMENT
THROUGH HISTORY
WASH COPIOUSLY WITH WATER FOR 15
MINUTES.
SODIUM BICARBONATE SOLUTIONS
MAGNESIUM SULFATE PASTE.
MAGNESIUM OXIDE PASTE.
AMMONIA SOLUTIONS & INHALANT.
HYAMINE SOLUTIONS 0.2% (2 gm
BENZEHTONIUM CHLORIDE IN 1 LITER OF ICE
WATER).
SUGGESTED TREATMENT
THROUGH HISTORY
ZEPHIRAN 0.13% (1.3 gm BENZALKONIUM
CHLORIDE IN 1 LITER OF ICE WATER).
CALCIUM GLUCONATE SOLUTIONS: 10%, 5%,
2.5%, 1%
CALCIUM GLUCONATE GEL 2.5%.
CALCIUM ACETATE SOLUTIONS.
ORAL CALCIUM & MAGNESIUM BASED
ANTACIDS AND SOLUTIONS.
SUGGESTED TREATMENT
THROUGH HISTORY
INTR-ARTERIAL CALCIUM TECHNIQUE (BOLUS
AND SLOW INFUSION).
INTRA-VENOUS CALCIUM TECHNIQUE (BIEAR
BLOCK).
HEXAFLUORINE RINSING SOLUTION.
DMSO + CALCIUM GLUCONATE SOLUTION.
FIRST
AID
PROCEDURES
FIRST AID SKIN EXPOSURE
 MINOR BURNS
Burns smaller than 2 square inches of body
surface, such as small droplets, or very small
skin burns, low concentration gas or solution
exposures.
 MAJOR BURNS
Burns larger than 2 square inches with A.H.F.
AFTER DECONTAMINATION
Initiate calcium gluconate 2.5% gel
inunction. Note the time you start this step.
Obtain medical attention (call).
If pain does not subside in 20-30 minutes,
go to medical treatment.
FIRST AID: EYES
ALL EXPOSURES ARE CONSIDERED SEVERE.
 DECON:
USE EYEWASH, A GLASS OR LOW PRESSURE
WATER HOSE. MAXIMUM TIME IS 5 MINUTES.
IRRIGATE: 500cc to 1000cc OF A 1% CALCIUM
GLUCONATE SOLUTION IN NORMAL SALINE PER
EYE.
FIRST AID: EYES
 SEEK SPECIALIZED MEDICAL ATTENTION
IMMEDIATELY. USE CALCIUM GLUCONATE AT 1%
CONCENTRATION UNTIL MEDICAL HELP IS
REACHED.
 IF THERE IS SKIN EXPOSURE, ALSO FOLLOW
SKIN DECONTAMINATION AND FIRST-AID
PROCEDURES.
FIRST AID INHALATION
 DECON
 ADMINISTER OXYGEN AT 12 LTS. PER MINUTE.
 START NEBULIZING A 2.5% SOLUTION OF
CALCIUM GLUCONATE IN NORMAL SALINE,
USING A STANDARD NEBULIZER OR ULTRA
NEBULIZER. PREFERABLY NOSE AND MOUTH
MASK AND ¾ IN. TUBING
 OBTAIN MEDICAL ASSISTANCE.
FIRST AID: INGESTION
 CONCIOUS PATIENT:
GIVE ORALLY HIGH AMOUNTS OF ANY CALCIUM
OR MAGNESIUM BASED ANTACID,
EFFERVESCENT CALCIUM IN WATER, MILK OR
WATER.
DO NOT INDUCE VOMITING!
 UNCONCIOUS PATIENT:
OBTAIN MEDICAL ASSISTANCE IMMEDIATELY.
 DO NOT FORGET TO DECONTAMINATE SKIN OR
EYES IF THEY WERE EXPOSED.
SECONDARY
DECONTAMINATION
PROCEDURES
SECONDARY
DECONTAMINATION
 EXAMINE & DECONTAMINATE:
-EAR CANALS
-MOUTH
-NOSE
-ANUS
-VAGINA
 EXAMINE & DECONTAMINATE SKIN FOLDS:
-NECK
SECONDARY
DECONTAMINATION
-AXILARY REGIONS
-SUB-MAMMARIAN FOLDS
-GROIN
-BEHIND THE KNEES
-INTER-DIGITAL FOLDS
 EXAMINE & DECONTAMINATE BELOW THE NAILS
OF:
-HANDS
-FEET
SECONDARY
DECONTAMINATION
 EXAMINE & DECONTAMINATE AREAS COVERED
WITH HAIR:
-SCALP
-PUBIS
-OTHER AREAS AS NEEDED
ELECTROCARDIOGRAPHIC
EFFECTS
 PROLONGED Q-T INTERVAL
(DUE TO HYPOCALCEMIA).
 NORMAL SERUM CALCIUM LEVELS:
2.25 TO 2.6 mmol/lt
9 TO 10.5 mg/dl
MEDICAL
TREATMENT
PROCEDURES
FLUORIDE IN SERUM OR IN
URINE
CLINICALLY- THE BEST INDICATOR IS URINE
FLUORIDES. EASY TO DO, RESULTS IN MINUTES
AND DEPENDABLE .
FLUORIDES IN SERUM ARE NOT RELIABLE
INDICATORS BECAUSE IT DOES NOT PROVIDE A
GOOD MEASURE OF EXPOSURE TO FLUORIDES,
AND IS COMPLICATED TO PERFORM, MAY TAKE
DAYS BEFORE REPORTED.
LONG TERM EFFECTS
 FIRST:
SEQUELA NORMALLY ARE ESTABLISHED IN THE
SUB-ACUTE TIME PERIOD AFTER EXPOSURE
AND ARE NORMALLY STABLE, SUCH AS:
*SKIN HYPO-PIGMENTATION
*KELOID SCARING
*DEEP SEATED SCARING
*SURGICAL SCARS
*NEUROLOGIC, LIVER AND KIDNEY
DISFUNCTION MAY PERSIST IF DAMAGE IS
SEVERE.
LONG TERM EFFECTS
 SECOND
THE FOLLOWING HAVE NOT BEEN OBSERVED:
*HYPER-REACTIVE AIRWAYS
*KIDNEY, LIVER OR CNS DYSFUNCTION
*CANCER
*REPRODUCTIVE PROBLEMS, ETC
(SEE TOXICOLOGY)
CALCIUM GLUCONATE AS
THE TREATMENT OF
CHOICE
WHY ?
*EASY TO USE.
*CAN BE USED IN FIRST AID & MEDICAL
TREATMENT.
*CAN BE USED TOPICALLY, INFILTRATED,
INHALED, OPTHAMICALLY AND
INTRAVENOUSLY.
*NO SOPHISTICATED MEDICAL EQUIPMENT
REQUIRED, SUCH AS ARTERIAL CATHETERS,
IV INFUSERS, ETC.
*EASY TO PREPARE IN GEL FORM OR
SOLUTIONS.
*TREATMENT IS FAST AND EFFECTIVE.
*THE RESULTING REACTION CHEMICAL
IS PRIMARILY GLUCOSE AS COMPARED
TO AMMONIUM FLUORIDE & ACETIC
ACID, IN THE CASE OD AMMONIA
COMPOUNDS OR CALCIUM ACETATE,
RESPECTIVELY.
*CALCIUM IS MUCH MORE FAVORED TO BIND
WITH FLUORIDE IN THE BODY.
*NONE OR MINOR TISSUE IRRITATION AT
DESCRIBED CONCENTRATIONS.
*EXCELLENT RESULTS IN BOTH HIGH & LOW
CONCENTRATION EXPOSURES OF HF.
*NO SECONDARY EFFECTS AT THERAPEUTIC
LEVELS.
*NO NEED FOR SOAKING OR COOLING WITH
RESULTING HYPOTHERMIC OR VASCULAR
RISKS.
* IT IS AN EXCELLENT OUTSIDE SOURCE OF
CALCIUM THAT WILL BIND THE FLUORIDE,
AND IN DOING SO, WILL HELP AVOID
HYPOCALCEMIA, AND THE CREATION OF
TOXIC COMPOUND IN THE BODY.
*CAN BE USED IN THE PRODUCTION FIELD,
IN TRANSPORTATION INCIDENTS AND IN
HOSPITALS.
ALGORITHMS FOR
EMERGENCY MEDICAL
PROCEDURES FOR
HYDROFLUORIC ACID
EXPOSURE
HF Exposure
Decontamination
= DECON =
Procedures
Recognize Exposure Rout (s)Skin - Eyes - Inhalation - Ingestion
Evaluate the
severity
of the Exposure
Pain
Subsides
Minor
Major
First aid
Protocols
Systemic
Effects
Pain Continues
Go to
Medical
Treatment
Protocols
and
Systemic
Effects
Treatment
Protocols
Skin Exposure
Decontamination Procedure.
•Go to the nearest water source or safety shower.
•Open the valve.
•Remove all clothing, shoes, and jewerly.
•Remove eye protection last while facing the water flow.
•Remember no more than five (5) minutes under the water flow.
Minor
Exposure
Signs & Symptoms.
•Low concentration of HF<30%
•< 3 sg.in. Of exposed skin. To AHF.
•Injury appears hours after exposure.
•Superficial injury.
•Conscious and Stable
Decontamination Procedures for HF Containing Oils & Tars.
Where the possibility of Exposure Exists.- and
wearing acid resistant gloves.
A) Remove the oil of Tor with baby-oil and Mechanical
Means such as gauze,or tung depressors consider
the materials used as a Hazardous waste and
handle them adequately.
B) Remove baby-oil residue thoroughly by washing
with soap and water.
C) Follow basic decontamination procedure.
Major
Exposure
Signs & Symptoms.
•AHF or high concentration >30%
•> 3 sg.in of exposed skin to AHF.
•Injury appears immediately after
exposure.
•Deep or extensive injury.
•Unconscious - or unstable.
•Face, Neck, Groin, genital exposure.
•Cardiac Arrithmia. (Irregular heart beats).
First-Aid Procedures.
First-Aid Procedures.
•Rub-in calcium-gluconate 2.5% gel
for 20 to 30 minutes.
•Pain significantly decreases or
subsides.
Stop & observe.
•Never use local anesthetics.
•Rub-in calcium-gluconate 2.5%
gel for 20 to 30 minutes.
•Pain does not decrease or
subsides - within the first 20 to
30 Minutes.
Medical Treatment Procedures.= Injury Treatment =
•Inject into, around and under all injuries a solution of a
2.5% calcium gluconate solution in normal saline.
= Systemic Toxicity Treatment =
•Start IV drip of 1000 cc in normal saline +20 cc of 10% calcium
gluconate.
•The amount of solution administered will depend on the levels
of Serum calcium (titer).
•Monitor ECG, Electrolytes with special interest on Ca, Mg, Na
and K, Chest “x” Rays, Blood gases, Ph, Blood Chemistry,
fluoride in urine and blood, liver & kidney function.
•Consider.- Intra Arterial slow infusion, of calcium gluconate
and
•Consider Hemodialisis for the removal of serum Fluorides.
Skin Exposure
Decontamination Procedure.
Decontamination Procedures for HF Containing Oils & Tars.
•Go to the nearest water source or safety shower.
Where the possibility of Exposure Exists.- and wearing acid
resistant gloves.
A) Remove the oil of Tar with baby-oil and Mechanical
Means such as gauze, or tongue depressors (consider the
Material used as a Hazardous waste and handle them
adequately).
•Open the valve.
•Remove all clothing, shoes, and jewelry.
•Remove eye protection last while facing the water flow.
•Remember no more than five (5) minutes under the
water flow.
B) Remove baby-oil residue thoroughly by washing
with soap and water.
C) Follow basic decontamination procedure.
Minor
Exposure
Signs & Symptoms.
•Low concentration of HF<30%
•< 3 sg.in. Of exposed skin. To AHF.
•Injury appears hours after exposure.
•Superficial injury.
•Conscious and Stable
Major
Exposure
Signs & Symptoms.
•AHF or high concentration >30%
•> 3 sg.in of exposed skin to AHF.
•Injury appears immediately after
exposure.
•Deep or extensive injury.
•Unconscious - or unstable.
•Face, Neck, Groin, genital exposure.
•Cardiac Arrithmia.
(Irregular heartbeats).
First-Aid Procedures.
First-Aid Procedures.
•Rub-in calcium-gluconate 2.5% gel
for 20 to 30 minutes.
•Pain significantly decreases or
subsides.
Stop & observe.
•Never use local anesthetics.
•Rub-in calcium-gluconate 2.5%
gel for 20 to 30 minutes.
•Pain does not decrease or
subsides - within the first 20 to
30 Minutes.
Medical Treatment Procedures.= Injury Treatment =
•Inject into, around and under all injuries a solution of a 2.5%
calcium gluconate solution in normal saline.
= Systemic Toxicity Treatment =
•Start IV drip of 1000 cc in normal saline +20 cc of 10% calcium
gluconate.
•The amount of solution administered will depend on the levels
of Serum calcium (titer).
•Monitor ECG, Electrolytes with special interest on Ca, Mg, Na
and K, Chest “x” Rays, Blood gases, Ph, Blood Chemistry,
fluoride in urine and blood, liver & kidney function.
•Consider.- Intra Arterial slow infusion, of calcium gluconate
and
•Consider Hemodialisis for the removal of serum Fluorides.
Respiratory Exposure
Decontamination Procedures.
•Not Possible =
•If gaseous exposure occurs skin and eye decontamination
is necessary.
Minor
Exposure
Signs & Symptoms.
•No signs & symptoms.
•Minor coughing.
•Minor swelling and Eritlema.
First-Aid Procedures.
•Administer O2 at a rate of 12 Lts./min.
•Nebulize calcium gluconate 2.5% in
normal saline for 15 to 20 min.
•Obtain Medical Evaluation and
observe.
Major
Exposure
Signs & Symptoms.
•Coughing
•Labored Breathing.
•Shortness of Breath
•Erithema
•Swelling
•Bleeding
•Upper Airway Edema.
•Pulmonary Edema.
•Cardiac Arrithmia. (Irregular heart beats).
First-Aid Procedures.
•Administer O2 at a rate of 12 lts./min.
•Continuously nebulize calcium
gluconate 2.5% in normal saline until
medically evaluated.
•If respiratory assistance is needed use indirect methods - (Bag-microshield).-
Medical Treatment Procedures.=Respiratory Track = & Systemic Toxicity.
•Air Way & Breathing must be secured. Evaluate ABC; and
follow ACLS procedures.
•Positive Pressure Assistance and Positive end expiratory
pressure (peep). Are necessary.- until edema has resolved.
•Evaluate and monitor.- Chest “x” Rays, Blood Gases, ECG,
Electrolytes with special interest in Ca, Mg, Na, and K, Blood
Chemistry, fluorides in urine and blood, liver & Kidney functions.
•Start IV drip of 1000 cc in normal seline. +20 cc of 10% Calcium
Gluconate.
•The amount of the solution will depend on the levels of serum
calcium.
•Consider Hemodialisis for the removal of serum Fluorides.-
Respiratory Exposure
Decontamination Procedures.
•Not Possible
•If gaseous exposure occurs skin and eye decontamination
is necessary.
Minor
Exposure
Signs & Symptoms.
•No signs & symptoms.
•Minor coughing.
•Minor swelling and Eritlema.
Major
Exposure
Signs & Symptoms.
•Coughing
•Labored Breathing.
•Shortness of Breath
•Erithema
•Swelling
•Bleeding
•Upper Airway Edema.
•Pulmonary Edema.
•Cardiac Arrithmia. (Irregular heart beats).
First-Aid Procedures.
•Administer O2 at a rate of 12 Lts./min.
First-Aid Procedures.
•Administer O2 at a rate of 12
lts./min.
•Nebulize calcium gluconate 2.5% in
normal saline for 15 to 20 min.
•Continuously nebulize calcium
gluconate 2.5% in normal
saline until medically evaluated.
•Obtain Medical Evaluation and
observe.
•If respiratory assistance is
needed - use indirect methods
(Bag-microshield).
Medical Treatment Procedures.=Respiratory Track = & Systemic Toxicity.
•Air Way & Breathing must be secured. Evaluate ABC;
and follow ACLS and ATLS procedures.
•Positive Pressure Assistance and Positive end expiratory
pressure (peep). Are necessary.- until edema has resolved.
•Evaluate and monitor.- Chest “x” Rays, Blood Gases, ECG,
Electrolytes with special interest in Ca, Mg, Na, and K, Blood
Chemistry, fluorides in urine and blood, liver & Kidney functions.
•Start IV drip of 1000 cc in normal seline. +20 cc of 10% Calcium
Gluconate.
•The amount of the solution will depend on the levels of serum
calcium.
•Consider Hemodialisis for the removal of serum Fluorides.-
Eye Exposure
Decontamination Procedure.
•Go to the nearest water source or eye wash.
•Open the valve.
•Mechanically maintain eye lids open, or ask for help.
•Wash for five minutes (5) and no more.
Minor
Exposure
Signs & Symptoms.
•Irritation of conjunctiva layer and
eye lid skin (minor).
•Conjuctival injection.
•No evidence of corneal injury.
•No vision loss
First-Aid Procedures.
•Irrigate eyes with a 1% Calcium
gluconate solution in normal saline
1000 cc per eye (15 min. aprox.).
•The use of an irrigating system
(Morgan Lens) after using a local eye
anesthetic (one or two drops per eye)
should be considered.
•Obtain specialized medical evaluation.
Major
Exposure
Signs & Symptoms.
•Severe irritation of the conjunctival
eye, and skin burn to eye lids.•Conjuctival injection and swelling.
•Corneal “Opacification” or Pitting.
•Vision loss.
First-Aid Procedures.
•Irrigate eyes with a 1% calcium
gluconate solution in normal saline
1000 cc per eye (15 min. Aprox.).•The use of an irrigating system
(Morgan Lens) after using a local eye
anesthetic (one or two drops per eye)
should be considered.
•Specialized Medical Evaluation should
be done (Slit lamp, etc).
Medical Treatment Procedures.•If necessary continue treatment with a 1% solution of calcium
gluconate in normal saline.•Antibiotics and steroids can be used as indicated by eye
specialist.
•Monitor ocular pressure.
•Evaluate corneal opacification regularly.•If skin, ingestion or inhalation exposure occurs do not forget to
decontaminate, and follow systemic toxicity treatment protocols.
•Psychological support may be necessary.
Eye Exposure
Decontamination Procedure.
•Go to the nearest water source or eye wash.
•Open the valve.
•Mechanically maintain eye lids open, or ask for help.
•Wash for five minutes (5) and no more.
Minor
Exposure
Major
Exposure
Signs & Symptoms.
Signs & Symptoms.
•Irritation of conjunctiva layer and
eye lid skin (minor).
•Conjuctival injection.
•No evidence of corneal injury.
•No vision loss.
•Severe irritation of the conjunctival
eye, and skin burn to eye lids.•Conjuctival injection and swelling.
•Corneal “Opacification” or Pitting.
•Vision loss.
First-Aid Procedures.
•Irrigate eyes with a 1% Calcium
gluconate solution in normal saline
1000 cc per eye (15 min. aprox.).
•The use of an irrigating system
(Morgan Lens) after using a local eye
anesthetic (one or two drops per eye)
should be considered.
•Obtain specialized medical evaluation.
First-Aid Procedures.
•Irrigate eyes with a 1% calcium
gluconate solution in normal
saline 1000 cc per eye (15 min.
Aprox.).•The use of an irrigating system
(Morgan Lens) after using a local
eye anesthetic (one or two drops
per eye)
should be considered.
•Specialized Medical Evaluation
should be done (Slit lamp, etc).
Medical Treatment Procedures.•If necessary continue treatment with a 1% solution of calcium
gluconate in normal saline.•Antibiotics and steroids can be used as indicated by eye
specialist.
•Monitor ocular pressure.
•Evaluate corneal opacification regularly.•If skin, ingestion or inhalation exposure occurs do not forget to
decontaminate, and follow systemic toxicity treatment protocols.
•Psychological support may be necessary.
Ingestion
Decontamination Procedures.
•Not Possible
•If skin or eyes have been exposed decontamination
procedures should be followed.
Minor
Exposure
Major
Exposure
Signs & Symptoms.
ALL EXPOSURES ARE
CONSIDERED MAJOR.
•Erithema of oral mucousa.
•Oral injury.
•Bleeding of the oral cavity.
•Systemic Toxicity.
•Possible bronchial or pulmonary
problems if the patient vomited.
First-Aid Procedures.
•Do Not induce Vomiting.
•If patient is able to swallow give oral
calcium solutions - or - calcium based
antacids - milk or water.
•If unconscious obtain Medical Attention
Immediately
Medical Treatment Procedures.•HF destroys fiber optics - consider before using endoscopic
techniques.
•Establish IV drip 1000 cc Normal Saline + 20cc - 10% calcium
gluconate.
•If possible install a naso-gastric or oral-gastric tube.
•Gastric Lavage with calcium solutions, calcium or magnesium
based antacids.
Systemic Toxicity Control.
•The amount of calcium or magnesium to be administed will
depend on the serum levels.
•Monitor ECG, Electrolytes, with special interest on Ca, Mg, K,
and Na, Chest X Rays may be necessary, blood gases, blood
Chemistry, Kidney and Liver functions.
•Follow ACLS ATLS procedures.
•Consider Hemodialisis for the removal of fluorides in Blood.
Ingestion
Decontamination Procedures.
•Not Possible
•If skin or eyes have been exposed decontamination
procedures should be followed.
Minor
Exposure
Major
Exposure
Signs & Symptoms.
ALL EXPOSURES ARE
CONSIDERED MAJOR.
•Erithema of oral mucousa.
•Oral injury.
•Bleeding of the oral cavity.
•Systemic Toxicity.
•Possible bronchial or pulmonary
problems if the patient vomited.
First-Aid Procedures.
•Do Not induce Vomiting.
•If patient is able to swallow give
oral
calcium solutions - or - calcium
based
antacids - milk or water.
•If unconscious obtain Medical
Attention Immediately
Medical Treatment Procedures.•HF destroys fiber optics - consider before using endoscopic
techniques.
•Establish IV drip 1000 cc Normal Saline + 20cc - 10% calcium
gluconate.
•If possible install a naso-gastric or oral-gastric tube.
•Gastric Lavage with calcium solutions, calcium or magnesium
based antacids.
Systemic Toxicity Control.
•The amount of calcium or magnesium to be administed will
depend on the serum levels.
•Monitor ECG, Electrolytes, with special interest on Ca, Mg, K,
and Na, Chest X Rays may be necessary, blood gases, blood
Chemistry, Kidney and Liver functions.
•Follow ACLS ATLS procedures.
•Consider Hemodialisis for the removal of fluorides in Blood.
PATIENT’S PROGNOSIS &
LONG-TERM EFFECTS WILL
DEPEND UPON:
 EXPOSURE TIME.
 DECONTAMINATION
 ROUTE OF ENTRY
 CONCENTRATION OF HF.
 TYPE OF TREATMENT GIVEN
 HOW FAST TREATMENT WAS GIVEN.
 GENERAL STATE OF THE PATIENT.
IF THE TREATMENT IS OPPORTUNE AND
ADEQUATE, PROGNOSIS WILL BE GOOD IN
MOST CASES.
MEDICATION & DRESSING
MATERIALS THAT SHOULD
EXIST WHEREVER HF IS
HANDLED
1. IN THE FIELD
 DECONTAMINATION UNITS CONSIST
OF:
√SAFETY SHOWER
√EYEWASH
√SEALED BOX WITH:
*PAIRS OF GLOVES
*2 TUBES OF HF GEL 30 GRAMS EACH
*1 ALUMINIZED PLASTIC SHEET
2. IN AN AMBULANCE,
MEDICAL AREAS, OR ANY
WHERE MEDICALLY TRAINED
PROFESSIONALS ARE
AVAILABLE
 ALUMINIZED PLASTIC SHEETS
 HF GEL 2.5%
 EYE IRRIGATION SOLUTION 1%
 NEBULIZING SOLUTION 2.5%
 5 CALCIUM GLUCONATE AMPS
 NORMAL SALINE IV SOLUTION
 WATER SOLUBLE LUBRICANT GEL
 LOCAL OPTHAMALIC ANESTHETIC
 GLOVES – LATEX, PVC OR NEOPRENE
 HYPODERMICS, SEVERAL SIZES & CALIBERS,
STAINLESS STEEL NEEDLES
 MORGAN LENS
 MORGAN LENS DELIVERY SYSTEM (Y)
 IV DELIVERY SYSTEMS
 COLD PACKS
 TRACHEOSTOMY KIT
 WELL STOCKED EMERGENCY CART
 DEFIB / MONITOR UNIT
 INHALATION THERAPY EQUIPMENT
 NEBULIZERS
 MINOR SURGICAL KIT
 CALCIUM EFFERVESCENT TABLETS
 DRESSING MATERIALS
3. HYDROFLUORIC
ACID KIT
SHOULD BE IN CONTROL ROOMS OR WELL
CONTROLLED AREAS. THEY ARE COMPOSED OF
TWO MAIN PARTS:
A. INHALATION THERAPY UNIT O(2) CYLINDER
VALVE, FLOWMETER PRESSURE METER
NEBULIZER, TUBING & MASK.
B. ONE PORTABLE CONTAINER THAT CONTAINS:
*4 PAIRSOF GLOVES – LATEX, PVC, NEOPRENE
*1 FLASHLIGHT
*1 LITER OF 1% CALCIUM SOLUTION IN
NORMAL SALINE
*1 LITER OF 2.5% CALCIUM SOLUTION IN
NORMAL SALINE
*8 TUBES OF HF GEL, 2.5%
*5 AMP OF CALCIUM GLUCONATE, 10% SOL
*5 NEEDLES, 25 CAL 1 ½” LONG, STAINLESS
STEEL
*20 STERILE GAUZE
*2 TOURNIQUETS
*2 IV TUBING SETS
*4 BOTTLES OF ANTACID (CALCIUM OR
MAGNESIUM BASED)
*2 IV TUBING SETS
*4 BOTTLES OF ANTACID (CALCIUM OR
MAGNESIUM BASED)
*1 BOTTLE OF EFFERVESCENT CALCIUM
TABLETS
*1 BOTTLE OF LOCAL EYE ANESTHETIC
*2 COLD PACKS
*2 MAYO CANULAS
*2 ALUMINIZED PLATIC SHEETS
*1 TUBE OF LUBRICATING GEL
*2 STERILE CONTAINERS
*1 IV INFUSOR
*4 MORGAN LENSES
KEYS TO GOOD CONTROL
WITH HF
AVOID EXPOSURES THROUGH:
* CONTINUOUS EDUCATION.
* GOOD INDUSTRIAL HYGIENE PRACTICES.
* MAXIMUM SAFETY IN HANDLING HF ON & OFF-SITE.
*CONTINOUS MEDICAL TRAINING ON & OFF-SITE.
*PARTICIPATE IN NEIGHBORING COMMUNITY HOSPITALS,
EMS, AND OTHER AGENCIES, SO THAT YOU MAY BE
PREPARED FOR ANY CONTIGENCY.
SO , PRODUCE, STORE, HANDLE AND
DISPOUSE ALL HAZARDOUS CHEMICALS
WITH RESPECT AND KNOWLEDGE
FOR YOUR ATTENTION AND PATIENCE
THANK YOU
VERY MUCH !!!