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Treatment Protocol for Hydrofluoric Acid Burns Warning

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Treatment Protocol for Hydrofluoric Acid Burns Warning Safetygram 29 Treatment protocol for hydrofluoric acid burns Warning: Burns with concentrated hydrofluoric acid (HF) are usually very serious, with the potential for significant complications due to fluoride toxicity. Concentrated HF liquid or vapor may cause severe burns, metabolic imbalances, pulmonary edema, and life-threatening cardiac arrhythmias. Even moderate exposures to concentrated HF may rapidly progress to fatality if left untreated. Burns larger than 25 square inches (160 square cm) may result in serious systemic toxicity. Relief of pain is the only indication of effectiveness of treatment. Therefore the use of any analgesic agents is not advisable. Properties Hydrofluoric acid (HF) is an extremely powerful inorganic acid and a vigorous dehydrating agent. Anhydrous hydrofluoric acid and hydrofluoric acid in aqueous solutions range in appearance from colorless to slightly tinted. HF has a pungent odor. It is extremely corrosive. General health hazards Hydrofluoric acid exposure requires immediate specific and specialized medi- cal treatment. Not only can this strong acid cause burns, but the fluoride ion can be quickly absorbed through the skin. Fluoride ions can then attack under- lying tissues and can be absorbed into the bloodstream. HF, liquid or gaseous, may cause severe burns of the skin and deep tissues. If the eyes are exposed to HF, it may penetrate to internal structures. HF inhaled in high concentrations may cause glottitis (obstruction of the airway) and acute pulmonary edema. Absorption of HF may cause hypocalcemia due to HF’s fixation of blood calcium. Hyperkalemia may occur if severe hypocalcemia appears. A person who has HF burns greater than four (4) square inches should be admitted immediately to an intensive care unit and carefully monitored for 24 to 48 hours. Anyone who has been exposed to gaseous HF and experiences respira- tory irritation should also be admitted to and monitored in an intensive care unit. Blood sampling should be taken to monitor fluoride, potassium, and calcium levels. In some cases, hemodialysis is necessary for fluoride removal and for correction of hyperkalemia. The effects of exposure to HF may be Safety precautions First aid and medical delayed depending on the strength Be prepared!! Adequate personal pro- treatment of the solution. Solutions containing tective equipment must be provided greater than 50% HF will normally to each employee who may be ex- Skin burns cause an immediate recognizable and posed to HF. FIRST AID RESPONDERS Skin contacted by HF, vapor, or painful burn. Solutions containing AND MEDICAL PERSONNEL MUST aqueous solution rapidly produces an 20% to 50% HF may cause delayed WEAR RUBBER (NEOPRENE OR erythematous (reddened) area, often symptoms that can manifest in one POLYVINYL CHLORIDE [PVC]) GLOVES with a white or gray color at the sur- (1) to eight (8) hours. Solutions with WHEN TREATING HF BURNS TO face caused by coagulation of tissue. less than 20% HF may not cause AVOID HAND BURNS!! Employees 1. Immediately go to a safety shower symptoms for up to 24 hours. A must be properly trained in the wear- or other available water and flush similar delay in symptoms may be ing of personal protective equipment. with copious amounts of water. seen with respiratory and dermal Safety and handling procedures must Rinse off excess HF. Speed and contact. be taught to all relevant person- thoroughness in washing off the nel and these procedures must be acid is of primary importance. HF skin burns are usually enforced.Personnel who have been accompanied by severe, throbbing trained in the specialized HF first aid All clothing must be removed. pain that is thought to be due procedures must be available immedi- Continue under water until calcium to irritation of nerve endings by ately. Medical supplies must be readily gluconate gel is available. Calcium increased levels of potassium ions accessible at all times. (See Medical gluconate gel can be massaged into entering the extracelluar space to Supplies List.) skin while flushing with water. compensate for the reduced levels of calcium ions, which have been bound Local emergency medical respond- 2. Summon medical personnel and to the fluoride. RELIEF OF PAIN IS AN ers and hospitals must be included continue with first aid. IMPORTANT GUIDE TO THE SUCCESS in the first aid and medical training OF TREATMENT. for the facility. Effects of HF exposure 3. Apply calcium gluconate 2.5% gel are unique and must be treated in every 15 minutes and massage a specialized medical fashion. An continuously until the pain appropriate first response coupled disappears. Remember, rubber with HF-specific medical treatment is gloves must be worn while imperative. touching the victim. If pain recurs, apply calcium gluconate gel and massage while transporting the injured worker to an emergency room. 4. An alternate procedure is to soak the affected areas in an iced 0.13% water solution (1:750) of Zephiran® chloride (benzalkonium chloride solution, NF). Use ice cubes, not shaved ice, to prevent frostbite. If soaking is impractical, soaks or compresses may be used. Compresses should be changed every 2-4 minutes. Total immersion for areas such as fingers, hands, and feet is desirable. Do not use Zephiran solution for burns of the eyes. Zephiran is an eye irritant. 2 5. Continue procedure in #3 or #4 Eye burns 3. Give 100% oxygen by mask. while transporting to a medical 1. Flush immediatly with water for 4. As soon as possible, give a 2.5% to facility. at least 5 minutes while holding 3% calcium gluconate solution by eyelids open. 6. For deep burns, infiltration of 2.5% inhalation by Intermittent Positive aqueous calcium gluconate 2. Do not use oils, salves, ointments, Pressure Breathing (IPPB) using a solution with a small-gauge or HF skin burn treatments. nebulizer or by nebulizer alone. (#27-#30) needle around the affected area and intralesionally 3. If available, apply a few drops of 5. Refer patient to a pulmonologist may be necessary. Initially use no aqueous topical ophthalmic for further care. anesthetic solution to the eyes more than 0.5cc per square centi- 6. Carefully watch the patient for (proparacaine hydrochloride 0.5%). meter of burned skin. Do not distort edema of the upper airway with Do not delay treatment if ophthal skin appearance. Caution must be respiratory obstruction. The air mic anesthetic solution is not observed to avoid calcium way may be maintained by either readily available. overdosing. Administration should endotracheal intubation or trache- be performed by a physician only. 4. If sterile 1% calcium gluconate otomy if necessary. solution is available, flushing may 7. Do NOT use local anesthetics. 7. Pulmonary edema should be be limited to 5 minutes. Place a Resolution of pain is the means to treated by placing the patient on Morgan’s lens or the Eye Irrigator® determine effective medical IPPB with Positive End Expiratory on patient and irrigate eye treatment. Pressure (PEEP). Close supervision intermittently for 20 minutes with and continued use of a 2.5% to 3% 8. In some cases, it may be necessary an aqueous calcium gluconate calcium gluconate solution by to surgically remove damaged 1% solution. tissue and then apply calcium inhalation is necessary. 5. Transport patient to eye specialist gluconate (2.5% aqueous solution) 8. Patients with neck, chest, or head for further treatment. Continue to the affected area. burns should be watched for treatment as outlined in Step 4 delayed pulmonary edema. 9. The person with HF burns covering during transportation. greater than four (4) square inches 9. Hemodialysis must be considered 6. Instill aqueous calcium gluconate should be admitted immediately to for fluoride removal and to avoid or 1% solution every two to four hours an intensive care unit and correct hyperkalemia and recurrent for the next two to three days. monitored carefully for 24 to 48 hypocalcemia not responsive to hours. Serum calcium, potassium, Inhalation replacement therapy. and magnesium levels should 1. Remove victim from source of HF be monitored. The QT interval 10. A patient with a history of recent fumes. should be followed for signs of exposure who is experiencing hypocalcemia. Hypocalcemia 2. If not breathing, begin artificial respiratory irritation should be results in prolonged QT intervals. respiration immediately. admitted immediately to an intensive care unit and observed *NOTE: Mouth-to-mouth resuscita closely for 24 to 48 hours tion is not recommended. Administration of nebulized calcium gluconate should be considered. 11. Do not give stimulants. Patient must remain inactive for at least 24 hours. 3 Oral Ingestion Nail Burns Hypocalcemia 1. Do not induce vomiting. Do not 1. Immediately soak the nail in an Significant fluoride exposure via give patient any baking soda or iced solution of calcium gluconate. large burns, inhalation, or ingestion emetics. In the past, a 0.13% water solution will require observation for (1:750) of Zephiran Chloride hypocalcemia. 2. Give one (1) to three (3) glasses of (benzalkonium chloride solution, water. NF) was used successfully. An important way to monitor the necessity for and effectiveness of 3. Administer several vials of 10% 2. If pain does not completely cease, 2 treatment is EKG monitoring (for aqueous calcium gluconate orally. to 3 holes should be drilled in the example, prolongation of the Q-T (Calcium carbonate, Maalox, nail using an 18 gauge needle. interval may indicate hypocalcemia). Mylanta, or Milk of Magnesia may Continue soaking. also be used.) Calcium gluconate infusion (using 2 3. If pain still does not subside, the to 3 ampules of 10% calcium 4. Gastric lavage with lime water may nail must be removed by a physi- gluconate in one liter of 5% dextrose be performed by a physician cian. The nail bed should be solution or NSS to pass at the rate Extreme caution must be observed massaged with 2.5% calcium of 100 milliliters per hour) may when passing the Levin tube.
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