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- Chemical Treatment Guide: YELLOW

Chemical Treatment Guide: YELLOW
• Acids and acid mists
• Alkaline compounds
• Ammonia (liquid and gas)
• Chlorine gas and phosgene (CG)
• Methylene biphenyl isocyanate, ethyl isocyanate, and methylene dilsocyanate (MDI)
• Mustard (sulfur mustard): Lewisite, blister agents (H, HD, HS)

SIGNS AND SYMPTOMS

Low concentrations of airborne acids and alkalis can produce rapid onset of eye, nose, and throat irritation. Higher concentrations (low concentrations of ammonia) can produce cough, stridor, wheezing, and chemical pneumonia (non-cardiogenic pulmonary edema). Ingestion of acids and alkalis can result in severe injury to the upper airway, esophagus, and stomach. In addition, there may be circulatory collapse, as well as partial- or full-thickness burns.
End-stage symptoms may resemble organophosphate poisoning. However, patients will have
normal or dilated pupils (patients will not have pinpoint pupils). These patients should not be
given atropine or 2-PAM.

Supportive Care

• Remove the patient from the hazardous area (a).
• If the patient was exposed externally, remove his/her clothing and jewelry and decontaminate
with copious amounts of water. Provide ocular irrigation with normal saline (do not attempt
to neutralize with another solution)
• If the patient has external burns, see Burn Injuries.
• Contact the Poison Information Center (1-800-222-1222).
• If the patient has pulmonary edema, maintain adequate ventilation and oxygenation, and
provide pulmonary suction to remove fluid. Non-cardiogenic pulmonary edema should not be
treated with Lasix, but with positive end expiratory pressure (PEEP) or a CPAP mask

TREATMENT

• If the patient has bronchospasm: Albuterol (Ventolin®)
o 1 nebulizer treatment containing 2.5 mg of albuterol pre-mixed with 3 mL normal saline
Pediatric
- If - If > 1 year or > 10 kg: pre-mixed 2.5 mg in 3 mL of normal saline (0.083%). May repeat
twice PRN
• If bronchodilators are administered, may add ipratropium bromide (Atrovent®) 0.5 mg (0.5 mL)
To albuterol nebulizer treatment on first nebulizer treatment only.
• Adult and pediatric if the patient has inhaled chlorine or hydrochloric acid (HCl) and has
significant respiratory distress, administer sodium bicarbonate via nebulizer (8.4% 3 mL
mixed with normal saline 3 mL or 4.2% in 6 mL)

• If seizures continue for 3 minutes, Administer benzodiazepines:

- Midazolam (Versed) Adult dose 2 mg increments IV, IO, IM, or IN, Pediatric dose
0.1mg/kg, maximum single dose 4 mg IV, IO, IM. For IN administration use 0.2
mg/kg/dose (use 10 mg/2mL concentration), maximum single dose 5 mg; may repeat once
if necessary. Maximum total dose of 10 mg (e)
• If hypotension persists, administer 20 mL/kg normal saline IV PRN (maximum total dose is
60 mL/kg) Neonate 10mg/kg maximum total dose is 30mL/kg.
ALS Level 2 - None

PEARLS

(a) If risk of exposure from fumes is high, call for a hazardous materials team. Refer to the
appropriate hazardous materials PPE protocol, as the risk of secondary contamination is very
high.
(b) For IN administration, administer 1ml per nare, give half the volume in one nostril and the
other half of the volume in the other nare

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