Chlorine gas is a pulmonary irritant that causes acute damage to the upper and lower respiratory tract. It has been used as a chemical weapon and is still involved in some attacks. Exposure to chlorine gas leads to inflammation of the airways and lungs and can cause pulmonary edema. Symptoms range from irritation to death depending on concentration. Treatment involves oxygen, fluids, bronchodilators, and corticosteroids. Prolonged effects are possible but most recover without long-term issues.
Lead is a blue-gray, heavy, soft metallic element that occurs naturally in the earth’s crust. It is a malleable metal, so it can be easily worked - you can hammer it into protective sheets or make pipes and bend them easily. It is dense, and has good shielding protection against radiation, so it is used as ballast or to shield against penetrating forms of ionizing radiation. Metallic lead is tasteless and odorless, although some of the oxides and salts of lead taste sweet. (This sweet taste of lead salts is a source of problems for children!). Lead is insoluble in water, but some of the salts do dissolve, hence lead salts can be carried long distances in water supplies. Lead fumes will be easily formed when lead is heated. Although there is not a lot of lead in the earth’s crust – lead is ubiquitous, especially in modern industry.
A brief presentation on Arsenic poisoning encompassing 40 slides - also included is a quiz on toxicology at the end. This a special article from Telugudoctors.co.in; Hope you find it useful and informative. We have tried to make it as attractive, brief and informative as possible. Your advice would be useful in perfecting our future slides.
Asphyxia
Classification of Asphyxia
Mechanical Asphyxia
Mugging/ throttling
Mechanical Asphyxia
Pathological Asphyxia
Toxic or chemical Asphyxia
Environmental Asphyxia
Traumatic Asphyxia
Positional/postural Asphyxia
Iatrogenic Asphyxia
Tardieu’s or Bayard’s ecchymosis/spots
Hanging
Classification of Hanging
Cause of Death in Hanging
Fatal period in Hanging
Factors which influence the appearance of ligature mark ??
Judicial Hanging
Hangman’s fracture
Strangulation
ligature strangulation
Cause of death
Throttling or Manual Strangulation
Hyoid Bone Fractures
AUTOEROTIC
CHEMICAL Asphyxia
CHOKING
SMOTHERING Asphyxia
POSITIONAL Asphyxia
Drowning
Classification of Drowning
Typical or wet drowning
Mechanism of fresh water drowning
Mechanism of death in fresh water drowning
Mechanism of sea water drowning
Mechanism of death in sea water drowning
Atypical drowning
Dry drowning
Immersion syndrome
Near drowning
Shallow water drowning
Epidemiology of drowning
Cause of Death
Postmortem Examination
Froth
Reference
Sulphuric acid as a corrosive poison. the characteristics, fatal dose, fatal time, sign and symptoms, post-mortem appearance and medicolegal importance are discussed
INTRODUCTION:
Kerosene is a low viscosity flammable liquid.
Three types of kerosene mainly available in the market:
Commercial Kerosene ( Colourless)
PDS (Public Demand Supply – Blue dyed)
Aircraft fuel
Kerosene is known to cause harm to various body organs and systems.
Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes.
Kerosene poisoning is a very uncommon mode of poisoning.
EXPOSURE AND TOXICOKINETICS :
MECHANISM OF TOXICITY :
Toxicity is:
Due to exposure of un-combusted row kerosene.
Due to fuel performance additives.
Due to its exhaust emission
Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics.
CLINICAL SYMPTOMS:
Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma.
Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation.
Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis.
Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation.
TREATMENT:
In the case of acute exposures, the first step is to remove the patient from exposure.
In the case of ingestion of kerosene, Gastric lavage should not be undertaken.
Broad-Spectrum antibiotics like amoxicillin should be given through intravenously.
In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral.
Ceftriaxone is also included in the treatment system in combination with cefuroxime.
In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline.
HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION:
Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon.
On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity.
In the stomach, petechial hemorrhages with congested mucosa are found.
Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms.
In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis.
ANALYSIS:
Kerosene in biological material is isolated by steam distillation.
The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl.
The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether.
The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer.
On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm.
A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Lead is a blue-gray, heavy, soft metallic element that occurs naturally in the earth’s crust. It is a malleable metal, so it can be easily worked - you can hammer it into protective sheets or make pipes and bend them easily. It is dense, and has good shielding protection against radiation, so it is used as ballast or to shield against penetrating forms of ionizing radiation. Metallic lead is tasteless and odorless, although some of the oxides and salts of lead taste sweet. (This sweet taste of lead salts is a source of problems for children!). Lead is insoluble in water, but some of the salts do dissolve, hence lead salts can be carried long distances in water supplies. Lead fumes will be easily formed when lead is heated. Although there is not a lot of lead in the earth’s crust – lead is ubiquitous, especially in modern industry.
A brief presentation on Arsenic poisoning encompassing 40 slides - also included is a quiz on toxicology at the end. This a special article from Telugudoctors.co.in; Hope you find it useful and informative. We have tried to make it as attractive, brief and informative as possible. Your advice would be useful in perfecting our future slides.
Asphyxia
Classification of Asphyxia
Mechanical Asphyxia
Mugging/ throttling
Mechanical Asphyxia
Pathological Asphyxia
Toxic or chemical Asphyxia
Environmental Asphyxia
Traumatic Asphyxia
Positional/postural Asphyxia
Iatrogenic Asphyxia
Tardieu’s or Bayard’s ecchymosis/spots
Hanging
Classification of Hanging
Cause of Death in Hanging
Fatal period in Hanging
Factors which influence the appearance of ligature mark ??
Judicial Hanging
Hangman’s fracture
Strangulation
ligature strangulation
Cause of death
Throttling or Manual Strangulation
Hyoid Bone Fractures
AUTOEROTIC
CHEMICAL Asphyxia
CHOKING
SMOTHERING Asphyxia
POSITIONAL Asphyxia
Drowning
Classification of Drowning
Typical or wet drowning
Mechanism of fresh water drowning
Mechanism of death in fresh water drowning
Mechanism of sea water drowning
Mechanism of death in sea water drowning
Atypical drowning
Dry drowning
Immersion syndrome
Near drowning
Shallow water drowning
Epidemiology of drowning
Cause of Death
Postmortem Examination
Froth
Reference
Sulphuric acid as a corrosive poison. the characteristics, fatal dose, fatal time, sign and symptoms, post-mortem appearance and medicolegal importance are discussed
INTRODUCTION:
Kerosene is a low viscosity flammable liquid.
Three types of kerosene mainly available in the market:
Commercial Kerosene ( Colourless)
PDS (Public Demand Supply – Blue dyed)
Aircraft fuel
Kerosene is known to cause harm to various body organs and systems.
Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes.
Kerosene poisoning is a very uncommon mode of poisoning.
EXPOSURE AND TOXICOKINETICS :
MECHANISM OF TOXICITY :
Toxicity is:
Due to exposure of un-combusted row kerosene.
Due to fuel performance additives.
Due to its exhaust emission
Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics.
CLINICAL SYMPTOMS:
Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma.
Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation.
Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis.
Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation.
TREATMENT:
In the case of acute exposures, the first step is to remove the patient from exposure.
In the case of ingestion of kerosene, Gastric lavage should not be undertaken.
Broad-Spectrum antibiotics like amoxicillin should be given through intravenously.
In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral.
Ceftriaxone is also included in the treatment system in combination with cefuroxime.
In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline.
HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION:
Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon.
On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity.
In the stomach, petechial hemorrhages with congested mucosa are found.
Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms.
In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis.
ANALYSIS:
Kerosene in biological material is isolated by steam distillation.
The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl.
The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether.
The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer.
On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm.
A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Etiopathogenesis and pharmacotherapy of COPD
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by persistent respiratory symptoms and airflow limitation. The main symptoms include dyspnea, cough, and sputum production. COPD is caused by exposure to inhaled irritants, most often cigarette smoke, leading to chronic inflammation and structural changes in the lungs.
The predominant form of COPD is chronic bronchitis, which involves chronic cough and sputum production for at least 3 months per year for 2 consecutive years. This is associated with inflammation and eventual thickening of the bronchial tubes. Emphysema is another form of COPD characterized by permanent enlargement of airspaces and destruction of lung parenchyma.
The airflow limitation in COPD is due to a combination of parenchymal destruction (emphysema) and small airways disease (chronic bronchitis). The obstruction is generally progressive and irreversible. Diagnosis is based on symptoms, exposure history, and spirometry showing irreversible airflow limitation.
COPD treatment aims to reduce symptoms, improve exercise tolerance, prevent exacerbations, and slow disease progression. Smoking cessation is essential. Medications used include bronchodilators and inhaled steroids. Supplemental oxygen may be required in advanced disease. Exacerbations are treated with antibiotics, oral steroids, and other supportive therapies. Patients often have decreased quality of life and COPD is a leading cause of mortality worldwide.
Chloromethanes namely methyl chloride (CH3Cl), methylene chloride (CH2Cl2), Chloroform (CHCl3) and Carbon Tetrachloride (CCl4) are produced by direct chlorination of Cl2 in a gas phase reaction without any catalyst.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Background
◦ Chlorine gas is a pulmonary irritant with intermediate water solubility that causes acute damage in the upper
and lower respiratory tract.
◦ Currently, occupational exposures constitute the highest risk for serious toxicity from high-concentration
chlorine.
◦ Mixing of chlorine bleach (sodium hypochlorite) with ammonia or acidic cleaning agents is a common source
of household exposure.
◦ Chlorine gas has also been used repeatedly as a chemical weapon. [3]
◦ An estimated 93,800 tons of chlorine gas was produced during World War I, with more than half produced by
Germany.
◦ Chlorine was abandoned as a warfare agent when the use of gas masks was introduced and more effective
compounds were created and deployed.
◦ However, on at least three occasions in January and February 2007, insurgents in Iraq incorporated chlorine
tanks in vehicle-borne improvised explosive device (VBIED) attacks. Most of the deaths from the attacks were
caused by the explosion, but many people were treated and hospitalized for chlorine exposure. [5]
◦ The Organization for the Prohibition of Chemical Weapons (OPCW) has confirmed that since 2013, chlorine
gas has been the agent used in numberous chemical attacks in Syria affecting thousands of civilians and
[3]
3. Pathophysiology
◦ Chlorine is a greenish-yellow
◦ Prolonged exposure to chlorine gas may occur because its moderate
water solubility delays onset of upper airway symptoms for several
minutes. In addition, chlorine gas is heavier than air in its pure form,
causing it to remain near ground level and increasing exposure time.
◦ As the concentration of chlorine gas exposure increases, the severity of
symptoms and rapidity of onset increase. The IDHL (immediately
dangerous to life or health) is 10 ppm.
◦ Concentrations above 400 ppm are often fatal. [7]
4. ◦ Chlorine is moderately soluble in water and reacts in combination to form hypochlorous (HOCl)
and hydrochloric (HCl) acids. Elemental chlorine and its derivatives, hydrochloric and
hypochlorous acids, may cause biological injury.
◦ The chemical reactions of chlorine combining with water and the subsequent derivative reactions
with HOCl and HCl are as follows:
◦ a1) Cl2 + H2 O ⇔ HCl (hydrochloric acid) + HOCL (hypochlorous acid) or
◦ a2) Cl2 + H2 O ⇔ 2 HCl + [O-] (nascent oxygen)
◦ b) HOCl ⇔ HCl + [O-]
◦ Chlorine gas, when mixed with ammonia, reacts to form chloramine gas. In the presence of water,
chloramines decompose to ammonia and hypochlorous acid or hydrochloric acid. [8]
◦ Because of their high water solubility, chloramine exposures result in rapid symptom
development. However, for mechanistic reasons that are not clear, chlorine 88 nitrogenous
compounds result in less severe symptoms at onset. Because these initial symptoms are often
mild, however, they may not prompt immediate retreat, thus resulting in prolonged exposure, with
pulmonary and ocular symptoms predominating.
◦ Because of its intermediate water solubility and deeper penetration, elemental chlorine frequently
causes acute damage throughout the respiratory tract.
5. ◦ Cellular injury is believed to result from the oxidation of functional groups in cell
components, from reactions with tissue water to form hypochlorous and hydrochloric
acid, and from the generation of free oxygen radicals.
◦ The predominant targets of the acids are the epithelia of the ocular conjunctivae and upper
respiratory mucous membranes.
◦ The immediate effects of chlorine gas toxicity include acute inflammation of the
conjunctivae, nose, pharynx, larynx, trachea, and bronchi. Irritation of the airway mucosa
leads to local edema secondary to active arterial and capillary hyperemia. Plasma
exudation into the alveoli results in pulmonary congestion and edema.
◦ Pathologic findings are nonspecific. They include the following [16] :
• Pulmonary edema
• Pneumonia
• Pneumonitis
• Hyaline membrane formation
• Multiple pulmonary thrombosis
• Ulcerative tracheobronchitis
6. ◦ Dyspnea and Hypoxemia
◦ burns and corneal abrasions have occurred. Acids formed by the chlorine gas
reaction with the conjunctival mucous membranes are partially buffered by the
tear film and the proteins present in tears. Consequently, acid burns to the eye
are typically limited to the epithelial and basement membrane, rarely extending
to the deep endothelial cells.
◦ Acid burns to the periphery of the cornea and conjunctiva often heal
uneventfully. Burns to the center of the cornea may lead to corneal ulcer
formation and subsequent scarring.
◦ Solutions that are able to generate chlorine (eg, sodium hypochlorite bleach)
may cause corrosive injury if ingested. [7]
7. Exposure
◦ Chlorine liquid is presently used in cleaning agents (eg, bleach, disinfectants), in
water purification, and in the manufacture of items such as plastics. It is used in the
following industries:
• Pesticide
• Refrigerant
• Paper and pulp
• Textile
• Metallurgy
• Pharmaceutical
• Cosmetic
• Battery
8. ◦ In the United States, chlorine is the most common inhalational irritant.
◦ Most individuals exposed to chlorine gas recover without significant sequelae.
Even exposure to high-concentration chlorine gas is unlikely to result in
significant, prolonged pulmonary disease.
◦ Morbidity from moderate and severe exposures is typically caused by
noncardiogenic pulmonary edema.
◦ In serious exposures, sloughing of the pulmonary mucosa occurs in 3-5 days,
and oozing areas become covered with mucopurulent exudate. This chemical
pneumonitis is often complicated by secondary bacterial invasion.
◦ Resolution of pulmonary abnormalities in most individuals occurs over the
course of 1 week to 1 month after the exposure. Smokers and persons with
asthma are most likely to demonstrate persistence of obstructive pulmonary
defects.
◦ some patients with injured pulmonary epithelium have progressed to develop
pulmonary fibrosis.
10. Treatment
◦ the patient’s clothing should be removed if it has been contaminated with liquid
chlorine.
◦ Provide supplemental oxygen (humidified if possible) as necessary; depending on
the patient’s oxygen requirements, it may be delivered by nasal cannula, face mask,
nonrebreather mask, noninvasive positive pressure ventilation, or intubation.
Severe respiratory distress indicates the need for endotracheal intubation.
◦ Fluid restriction may be required and diuretics may be used to treat impending
pulmonary edema.
◦ Treat initial bronchospasm with beta agonists such as albuterol. Ipratropium may be
added. Poor responses may require terbutaline or aminophylline. Nebulized
lidocaine (4% topical solution) may provide analgesia and reduce coughing.
11. ◦ Other medications that may be used in the treatment of chlorine gas exposure
include nebulized sodium bicarbonate and inhaled or systemic corticosteroids;
however, evidence of efficacy is mixed. No evidence supports the use of
prophylactic antibiotics.
◦ Patients with skin or eye exposure to chlorine require copious irrigation with
saline. Consider ophthalmologic consultation for patients with significant
ocular involvement.
◦ Consider admission and observation for the following patients, even if they are
initially asymptomatic, as they are at increased risk of progression to
respiratory failure:
• Patients exposed to large concentrations in an enclosed environment
13. • studies showed that Cl-lipids
could initiate acute or
long-lasting injury due to their
reaction with protein side chains,
DNA, and lipids of the cells that
lining the airway epithelium.
• chlorofatty alcohols, are
considered proinflammatory
• chloramines, could activate
inflammatory cascades through
stimulation of mitogen-activated
protein Kinase and activation of
nuclear factor-κB via IκBα
oxidation, causing inflammatory
cells infiltration in alveolar space.
• In addition, chloramines could
inhibit Na+-dependent alveolar
fluid clearance and result in
pulmonary oedema.
14. ◦ N-acetyl cysteine, dimethylthiourea, aerosolized ascorbate, and deferoxamine
have been shown to alleviate Cl2 -induced injury in animal models of different
species.
◦ Cyclic AMP-elevating agents have been shown to protect against Cl2 -induced
lung injury too. Arformoterol mitigates the Cl2 toxicity on airway reactivity and
alveolar fluid clearance by increasing lung cyclic AMP level. Rolipram inhibits
degradation of the intracellular signaling molecule cyclic AMP, which alleviates
pulmonary edema, inflammation, and AHR.