Chemical Spill And Chemical Burn Management

1. Chemical Spill,
chemical gas leak
and there Burn
Management

2. •These are the substances with a definite
composition.
•Some chemicals occur in nature, such as water.
Other chemicals are manufactured, such as chlorine
(used for bleaching fabrics or in swimming pools).
What Is Chemical?

3. What is chemical spill?
If handled properly, a spill may be nothing more
than a nuisance. If handled improperly, a spill
can seriously disrupt your activities and the
work of your colleagues. At worst, a spill can
cause bodily harm or property damage.

4. Guidelines
The suggested guidelines in the event of a hazardous
chemical spill are included under the "Three C" program:

5. Control
The Spill,
Clean
Up The Spill
Contain
The Spill,
And

6. Emergency Preparedness
To prepare for spills, you should:-
• Learn about the hazards of the chemicals in your
laboratory,
• Write response procedures to address those hazards,
• Make sure that you have the equipment and training
necessary to follow those procedures.

7. Know Your Hazards
• One must identify the hazardous or potentially
hazardous properties of all chemicals used or
produced in your hospital.
• Before using any chemicals, you should evaluate the
consequences of potential spills and develop
appropriate response procedures.

8. Conti.
• If necessary, consult published data (such as material
safety data sheets and chemical dictionaries) for
response planning.
• Additionally, communicate potential hazards to other
workers in your area.
• When planning laboratory work and preparing for potential
problems, determine the hazard class of all the chemicals
to be used.

9. • Every laboratory should develop written spill response
procedures.
• Such procedures should detail the initial steps to take when
a spill occurs and include such elements as staff
responsibilities, communication methods, instructions on
using spill response equipment, and spill cleanup and
residue disposal.
Write Spill Response Procedures

10. Spill response procedures should include
elements such as
• A listing of appropriate protective clothing, safety equipment, and cleanup
materials required for spill cleanup (gloves, respirators, etc.) And an
explanation of their proper use;
• Appropriate evacuation zones and procedures;
• Availability of fire suppression equipment;
• Disposal containers for spill cleanup materials; and
• The first aid procedures that might be required.

11. • Before starting any work with chemicals, verify that all
necessary safety equipment and spill cleanup materials are
available and in good working order.
• ensure that the individuals who may be involved in spill
response are properly trained in equipment use and spill
cleanup procedures.
• Finally, regularly inspect all materials and equipment to ensure
that they will function properly when needed.
Make Materials and Equipment Available

12. • Whenever you spill a laboratory chemical or discover a spill or
release, tell your colleagues and laboratory director-no matter how
small or insignificant the spill or release appears.
• In order to assess a spill's risks and to obtain advice on cleanup
procedures, it always helps to solicit the advice of others.
• Even a small spill can result in a harmful exposure to you or others or
can result in hazards that are not obvious; therefore, notification of
regulatory officials may be required.
First Steps When a Spill Occurs: Communication
and Determination

13. Conti.
• When a spill occurs, you and others should move well away
from the area when determining the appropriate response.
• There are two types of spills:
Simple Spills:- which you can clean up yourself, A simple spill
is defined as one that, does not spread rapidly, does not
endanger people or property except by direct contact, and does
not endanger the environment.
Complex Spills:- which require outside assistance.

14. Steps to determine spill is simple or
complex:
(A)Evaluating the
spill's risks
Evaluating quantities
Evaluating the spill's
potential impact

15. A. Evaluate the Risks
• The first step in evaluating
whether a spill is "simple"
is to estimate the risks
created by the spill.
• In spill response, the key
risks of concern are
human health effects,
property damage, and
environmental damage.

16. • The next step to take when determining whether a spill is
"simple" is to evaluate the quantity of material released.
• If a spilled chemical is not hazardous, its cleanup (without
the assistance of an emergency response team) is
dependent on the ability to control the spill, as well as the
availability of sufficient spill control materials (e.g., an
absorbent for liquids).
B. Evaluate Quantities

17. Conti.
• Factors that may complicate a cleanup effort (such as
the unique characteristics of a spill's surroundings or the
restricted access to a spill) must be determined on a
case-by-case basis.
• If the spilled chemical is hazardous, the threshold
quantity for a simple spill cleanup depends on the spilled
chemical's physical properties and hazards.

18. This quantity depends on situational factors
such as:-
•The
training and
experience
of laboratory
personnel,
The
availability
of spill
control
materials,
The
availability
of personal
protective
equipment,
The physical
layout of the
spill
location.

19. C. Evaluate Potential Impacts
To determine whether a spill is simple or complex (which is often
the hardest part of spill response), you need to know
(1) the hazard(s) posed by the spilled chemical and
(2) the spill's potential impact.
Both these factors are, in large part, determined by the spill's size.

20. Way to Determine the simple spill
The type of
chemical(s)
spilled,
The
amount,
The hazardous
characteristics of
the spilled
chemical(s),
The
location,
The proper method
for cleaning up the
spill,
The personal
protective
equipment available,
and
The training of the
laboratory's
personnel.

21. Personal Protective Equipment (PPE)

22. Chemical
Splash Goggles

23. Face Shields

24. Gloves (Proper
Elastomer For The
Material In The
Lab)

25. Tyvek Suits

26. Chemical
resistant
Shoe/Foot
Coverings

27. Chemical
Resistant
Gas Mask

28. Chemicals NOT treated with immediate water
irrigation
• Do not immediately perform water irrigation for exposure to
chemicals that causes a harmful exothermic (heat-producing)
reaction or releases hazardous byproducts.
• Examples include dry lime, phenol, and metals such as
elemental potassium and sodium;

29. Skin decontamination
• Complete removal of the toxic chemical is
essential.
• Tissue damage continues for as long as
the chemical remains in contact with skin.
• Furthermore, destruction of the epidermis
allows substances to reach the dermis,
which is more permeable to chemicals
and may permit systemic absorption.

30. Dry lime
• This should be brushed off the skin prior to irrigation.
• It contains calcium oxide, which reacts with water to
form calcium hydroxide, a strong alkali.
• If water irrigation is begun inadvertently, stop
irrigation as soon as the presence of dry lime is
recognized, brush off any remaining particles, and
then restart water irrigation; intravenous pain
medication will also likely be needed.

31. Elemental Metals
• Elemental sodium, potassium, magnesium, phosphorous, lithium, cesium,
and certain reactive metal compounds (e.g., titanium tetrachloride)
combust or release hazardous byproducts when exposed to water.
• All fragments of such materials should be carefully removed with dry
forceps and placed in a non-aqueous solution (e.g., mineral oil).
• Afterwards, the affected area should be covered with mineral oil (or a
comparable non-aqueous solution) to prevent further exposure to air and
moisture.

32. Conti.
• The mineral oil may be wiped off and reapplied to ensure
that any remaining metal fragments are removed.
• Surgical debridement may be necessary if fragments are
embedded in the skin.

33. Phenol
• Removal requires wiping off the skin with sponges soaked in
50% polyethylene glycol (PEG) since phenol is not readily
soluble in water.
• Decontamination may be started with large amounts of water
until PEG is obtained.
• It is important to use copious amounts of water because
dilute solutions of phenol are more rapidly absorbed through
the skin.

34. Prior To Irrigation
Remove all clothing (including footwear and
jewelry) and brush off all dry agents. Any
suitable instrument can be used, such as a
dry brush or towel. A small number of
chemicals (e.g., dry lime, phenols, elemental
metals) should not be immediately irrigated
with water.
Antidote should not be given at initial phase
as it will cause exothermic reaction leading to
tissue damage.

35. Water irrigation
• Continue water irrigation if already
started at the scene of exposure,
otherwise immediately begin
irrigation with copious amounts of
water.
• Copious irrigation with water dilutes
and removes the large majority of
chemicals (a common mnemonic is:
"the solution to pollution is dilution")
• 2.5% calcium gluconate gel at 15 min.
interval local intra dermal.
• intra arterial injection of 10% calcium
gluconate
• Cardiac monitoring
• IV Calcium gluconate and calcium
chloride

36. Irrigation technique
• Moderately warm water in high volumes but
at low pressures should be used for
irrigation.
• Either a shower or a hose can be used.
• High pressure irrigation should be avoided
as it can splash chemicals on to unexposed
areas and drive them deeper into tissue.

37. Conti.
• Irrigation should begin at the site of contamination and
the eyes and face, if they are involved, followed by
adjacent to the exposed area. Decontamination of the
face prevents further inhalation or ingestion of any toxin.
• A patient with an exposure to a strong acid should also
be decontaminated as quickly as possible with copious
water if that is most readily available, and with a dry
towel or rag followed by copious water if immediate
water decontamination is not possible.

38. Conti.
• Concentrated strong acids, such as muriatic
acid (hydrochloric acid) and sulfuric acid, may
theoretically liberate heat due to ionization
when irrigated with water, which has led some
to caution against immediate irrigation.
However, based on a review of limited evidence
and the experience of a few clinicians, the most
important factor in mitigating tissue damage is
early decontamination.

39. Duration of irrigation
• For acid or alkali skin exposure, we suggest continuous
water irrigation until the pH of any exposed tissue
becomes neutral.
• Compared with acid burns, alkali burns may require a
much longer period of irrigation; two hours or more of
continuous irrigation may be required before the pH of
tissue exposed to a strong alkali returns to neutral.
• However, evidence is insufficient to guide the method and
duration of water irrigation.

40. Conti.
Burn severity depends upon the chemical
involved, duration of exposure, and depth
of penetration:
• Acids – These cause coagulation
necrosis that may result in sight-
threatening corneal ulceration and
scarring but tend to be self-limited.

41. Conti.
• Alkali – These usually cause more severe damage than
acids because they saponify phospholipid membranes,
which causes a liquefactive necrosis, rapid epithelial cell
death, and caustic penetration into the eye, Concentrated
ammonia can inflict severe injury to anterior ocular
structures after less than one minute of exposure, and can
cause deep eye injury and irreversible blindness within three
to five minutes. Glaucoma is a potential long-term sequelae
from the internal damage caused by alkaline exposure.

42. For alkaline burns
• Sodium bi-carbonate, calcium gluconate, IV pain relivers, electrolyte
management, ventilator support.
• Esophageal dilatation or colonic transposition is done for esophageal
stricture due to alkali burn.
• Gastrojejunostomy is done for acid induces pyloric stenosis.

43. Chemical Gas Leak
• If a gas leak occurs we would “shelter-in-place”,
• If one smell gas, such as propane or natural gas, immediately tell the
closest mentor, administrator or member of the office staff.
• Do not switch any light on or off.
• Do not plug or unplug any electrical outlet.
• Do not ignite any flame.

44. Conti.
• The place will evacuate until the building is deemed safe.
• When instructed to evacuate move quickly and calmly to the nearest
exit.
• Evacuation of the public will be done by crawling on the floor.
• Instruct the public to move to the other direction of the wind.
• Notify the manager/Incharge of the area
• Call for fire brigade

45. Inhalation Burn Management
• Limiting exposure and removing the patient from the exposure area
• Maintain secure airway: Intubation, tracheostomy if necessary
• Nebulized with a bronchodilator should be considered.
• Beta-2-adrenergic agonists, including albuterol and salbutamol, as well
as muscarinic receptor antagonists, such as tiotropium, have been shown
in animal models to improve pulmonary functioning in smoke inhalation
injury.
• Usage of steroids, in either inhaled or intravenous form, has not been
proven beneficial in clinical studies.

46. Conti.
• Early/prophylactic antibiotic usage is not recommended. Patients
with inhalation lung injury have been studied and found to have
greatly increased rates of pneumonia. A study conducted at
one institution reported a 4-fold increase in pneumonia for patients
with an inhalation injury. Therefore, antibiotics should be started
promptly when an empiric diagnosis of pneumonia is made.
• high oxygen therapy. Hyperbaric oxygen treatment (HBO) has been
shown to increase the clearance rate of CO from blood, but its
limited availability restricts its usage. Most health care centers
instead use 100% FiO2 oxygen therapy for treatment.

47. Conti.
• Hydrogen cyanide poisoning is difficult to determine in many cases.
Testing results are not readily available. One antidote, hydroxocobalamin,
may be given in patients with high suspicion of cyanide poisoning. It is
nontoxic and renally excreted. Side effects do include redding of the skin
and urine.
• Accurate treatment of possible toxic inhalation injuries is accomplished by
identifying the possible compounds inhaled, the duration and relative
concentration of exposure, and the water solubility of any toxic inhaled
agent.

49. Thank you..