Silane, Chlorosilane, and Related Compounds

SUBSTANCE IDENTIFICATION Silane (SiH4) is found as a gas with an unpleasant odor. Silane i5 used in semiconductor manufacture for the deposition of thin dielectric films. It is spontaneously com- bustible (pyrophoric) m air or may accumulate and detonate. The toxlcity of silane 1S limited to its irritant properties. Chlorosilanes (e.g., trichlorosilane [SiCl3H]) and organochlorosilanes (e.g., methy1chlorosilane [CH3SiCI3]) are found as clear-to-white, fuming liquids with a sharp odor. They are used in chemical synthesis; in the produc- tion of sihcon ftuids, silicon reSlllS,and amorphous silicon; and in semiconductor manufacture. Triehlorosilane is used to clean silieon water surfaces. Chlorosilanes or organochlorosilanes on contact with water forro hydrochloric add. There are hmited human toxicity data on these compounds. ROUTE OF EXPOSURE Skin and eye contact Inhalation Ingestion Skin absorptlon TARGET ORGANS Primary Skin Eyes Respiratory system Gastrointestmal system Blood Secondary Central nervous system CardlOvascular system Renal LlFE THREAT Respiratory tract irritation; pulmonary edema. SIGNS AND SYMPTOMS BY SYSTEM Cardiovascular: Tachycardia, hypotension, arrhythmias, and cardiovascular collapse. Respiratory: Respiratory tract irritation, rhinitis, sinusius, pharyngitis, eoughing, dyspnea, and hypoxia. Pulmonary edema. CNS: Headaches, dizziness, incoordination, decreased level of consciousness, seizures, and coma. Gastrointestinal: Salivation, nausea, vomiting, diarrhea, and abdominal pain. GI traet irritanon and mucosal burns. Eye: Irritation, lacrimation, corneal damage, and chemical bums. Skin: Irritant dermatitis and severe chemical bums. Renal: Kidney damage. Blood: Red blood cell destruction (hemolysis) may occur with exposure to tetrachlo- rosilane. 438 Silane, Chlorosilane, and Related Compounds 107

SYMPTOM ONSET FOR ACUTE EXPOSURE Immediate Some symptoms such as pulmonary edema may be delayed CO-EXPOSURE CONCERNS Other rcspiratory irritants THERMAl DECOMPOSITION PRODUCTS INCLUDE Carbon dioxide Carbon monoxide Hydrogen chloride Silicon dioxide Silicates Silane cxhibits almost complete combustion above 450° e MEDICAl CONDITIONS POSSIBlY AGGRAVATED BY EXPOSURE Respiratory system disorders DECONTAMINATION o Wear positive-pressure SCBA and protective equipment specified by references such as {he DOT Emergency Response Guidebook or rhe CANUTEC Inicial Emergency Response Guide. If special chernical protective clothing is required, consult the chemical manufacturer or specific protective clothing compattbilíty charts. o Delay entry until trained personnel and proper protective equipmcnt are availahle. o Remove patient fram contaminated area. . QUlckly remove and isolate patient' s c1othing, jewelry and shoes. o Gently brush away dry particles and blot excess liquids with absorbent material. . Rinse patient with warm water, 30°C/86°F, if possible. o Wash patient with Tineture of Green soap or a mild liquid soap and large quantities of water. . Refer to deconraminatlOn protocol in Section Three. IMMEDIATE FIRST AIO o Ensure that adequate decontamination has been earried out. . If vlctirn is not breathing. start artificial respiratian. preferably with a demand-valve resuscitator, bag-valve-mask devlce, or poeket mask as trained. Perfonn CPR If necessary. . Irnmediately flush contammated eyes with gently ftowing water. o Do llot mduce vomiting. If vomiting oecurs, lean patient forward or place on lcft sirle (head-dawn position. if possible) to maintain an open airway and prevent aspiration. . Keep victim quiet and maintain normal body temperature. o Obtain medical attention. BAStC TREATMENT . Estah!ish a patent airv.:ay.Suction if necessary. o Watch for signs 01'resplratory insufficiency and assist ventílations if necessary- o Administer oxygen by nonrcbreather rnask at 10 to 15 L/min. o Monitor for pulmonary edema and treat ir necessary (refer to pulmonary edema protocol In SectlOn Three). o Anticipate seizures and treat if necessary (refer to seizure pratocol in Sectlon Three). o Monitor tor shock and treat ir neeessary (rcfer to shock protocol in Sectíon Three). o For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with normal saline during transpon (refer to eye irrigarion prorocol in Section Three ). 439 107 Silane. Chlorosilane, and Related Compounds

. Do not use emetics. For ingestion, rinse mouth and administer 5 mllkg up to 200 mI of water for dilution if the patient can swallow, has a strong gag refiex, and does not drool. Administer activated charcoal (refer to ingestion protocol in Section Three and activated charcoal protocol in Section Four). . Cover skin bums wlth sterile dressings after decontammation (refer 10chemical bum protocol in Section Three). ADVANCED TREATMENT . Consider orotracheal or nasotracheal intubatlOn for airway control in the patient who is unconscious. Early intubation at the first sign of upper atrway obstruction may be necessary. . Monitor cardiac rhythm and treat arrhythmias if necessary (refer to cardiac protocol in Section Three). . Start an IV with DsW TKO. Use lactated Ringer's if signs of hypovolemia are present. Watch for signs of fluid overload. . Consider drug therapy for pulmonary edema (refer to pulmonary edema protocol in Section Three). . Treat seizures with diazepam (Valium) (refer tú diazepam protocol in Section Four). . For hypotension with signs of hypovolemia, administer fluid cautiously. Conslder va- sopressors for hypotension wÜh a normal fluid volume. Watch for signs of fluid overload (refer to shock protocol in Section Three). . Use proparacaine hydrochloride to assist eye irrigation (refer to proparacaine hydrochloride protocol in Section Four). INITIAL EMERGENCV DEPARTMENT CONSIDERATIONS . Useful initiallaboratory studies include complete blood count, semm electrolytes, blood urea nitrogen (BUN), creatinine, glucose, urinalysis, and baseline biochemical profile, including serum aminotransferases (ALT and AST), calcium, phosphorus, and magnesíum. Al1erial blood gases (ABGs), chest radiograph, and electrocardiogram may be required. . Positive end-expiratory pressure {PEEP)-assisted ventilatíon may be necessary in pa- tlents wah acute parenchymal ínjury who develop pulmonary edema or adult respiratory distress syndrome. . Endoscopy may be needed to assess extent of gastromtestinal damage. . Obtain toxicological consultatíon if necessary. SPECIAL CONSIDERATIONS . Products may be mixed in a variety of hydrocarbon solvents (e.g., methanol or tolu- ene). The solvent may contnbute to the overall toxicity. Identify solvent vehicle and consult appropriate guideline.

440 Phosphine and 108 Related Compounds

SUBSTANCE IDENTIFICATION A colorless gas with an odor of decaying fish. The reaction of hydrogen and various metal phosphides (e.g. alummum, zinc, or gallium phosphide) forms phosphine gas (PH3). Phosphides may also release phosphine gas on contact with water. Used in fu~ migation and as a doping agent in semiconductor manufacture, a polyrnerization inhibi- tor, and a chemical intermediate. Products may be toxic at air concentrations below the odor threshold of 1 to 2 ppm. ROUTES OF EXPOSURE Inhalation TARGET ORGANS Primary Cardiovascular system Respiratory system Secondary Central nervous system Gastrointestinal system Renal Heparic lIFE THREAT Severe pulmonary irritation leading to pulmonary edema. SIGNS AND SYMPTOMS BY SYSTEM Cardiovascular: Cardiac arrhythmias, hypotension, and cardiovascular collapse. Direet myocardlal muscle damage with elevated MB-CPK myocardial enzyrne release. Respiratory: Acute pulmonary edema. respiratory traet mitation, chest tightness, cough, dyspnea and tachypnea. CNS: Headache, dizzlness. tremors, fatigue, ataxia, paresthesia, seizures, and coma. Gastrointestinal: Nausea, vomiting, diarrhea, and abdommal pain. Intense thirst. Skin: Diaphoresis. Renal: Kidney damage. Hepatic: Liver damage, Jaundlce with associated elevations in semm aminorransferases. Metabali5m: Metabolíc acidosls. Other: Products may spontaneously ignite. SYMPTOM ONSET FOR ACUTE EXPOSURE Immediate Some reSplratory symptoms (pulmonary edema) may be delayed THERMAL DECOMPOSITION PRODUCTS INClUDE Hydrogen Phosphorus MEDICAl CONDITIONS POSS1BLY AGGRAVATED BY EXPOSURE Respiratory disorders CardlOvascular disorders 441 108 Phosphine and Related Compounds

DECONTAMINATION . Wear positIve-pressure SCBA and protective equipment specified by references such as the DOT Emergency Response GUldebook or [he CANUTEC /niria[ Emergency Response Guide. If special chemical protective c10thing is required, consult the chemical manufacturer or specific protective clothing compatibility charts. . Delay entry until trained personnel and proper protective equipment are available. . Remove patient frorn contaminated area. . QuickIy remove and isolate patienfs c10,thing jewelry, and shoes. . /f any concurrent [iquid or salid contaminatíon exists: Gently brush away dry partic1es and blot exeess liquids with absorbent material. Rinse patient with warm water, 30° C/86° F, if possible. Wash patient with Tincture of Green soap or a mild liquid soap and large quantities of water. . Refer to decontamination protocol in Section Three. IMMEDIATE FIRST AID . Ensure [hat adequate decontamination has been carried out. . If victlm is not breathing, start artificial respiration, preferably with a demand-valve resuscitator, bag-valve-mask device, or pocket mask as trained. Perforro CPR if necessary. . Irnmediately flush contaminated eyes with gently flowing water. . Do not induce vomiting. If vorniting oecurs, lean patient forward or place on left side (head-down position, if possible) to maintain an open airway and prevent aspiration. . Keep victirn quiet and maintain normal body temperature. . Obtain medical attention. BASIC TREATMENT . Establish a patent airway. Suction if necessary. . Watch for signs of respiratory insufficiency and assist ventilations if necessary. . Adminis[er oxygen by nonrebreather mask at 10 to 15 L/min. . Monitor for pulmonary edema and treal if necessary (refer to pulmonary edema protocol in Section Three). . Monitor for shock and treat if necessary (refer to shock protocol in SectlOn Three). . Anticipate seizures and treat if necessary (refer to seizure protocol in Section Three). . For eye contamination, flush eyes irnmediately with water. Irrigate eaeh eye continuously with normal saline during transport (refer to eye irrigation protocol in Section Three). ADVANCED TREATMENT . Consider orotracheal or nasotracheal intubation for airway control in the patlent who is unconscious or in respiratory arrest. . Positive-pressure ventilation techniques with a bag-valve-mask device may be benefi- cia!. . Monitor cardiac rhythm and treat arrhythmias if necessary (refer to cardiac protocol in Section Three). . Start an IV with DsW TKO. Use lactated Ringer's if signs of hypovolemia are present. Watch for signs of fluid overload. . Consider drug therapy for pulmonary edema (refer to pulmonary edema protocol in Section Three). . For hypotension with signs of hypovolemia, administer fluid cautlOusly. Consider va-

442 Phosphine and Related Compounds 108 sopressors for hypotenslOn with a nonnal fluid volume. Watch for signs of fluid overload (refer to shock protocol in Section Three). . Treat seizures with diazepam (Valium) (refer to diazepam protocol in Section Four). . Use proparacaine hydrochloride to assist eye irrigation (refer to proparacaine hydrochloride protocol in Section Four). INITIAL EMERGENCY DEPARTMENT CONSIDERATIONS . Useful initiallaboratory studies indude complete blood count, prothrombin time, semm electrolytes. blood urea nitrogen (BUN), creatinine, glucose, urinaIysis, and baseline biochemical profile, induding bilirubin, semm aminotransferases (ALT and AST). calcium, phosphorus, and magnesium. Determination of anion and osmolar gaps may be helpful. Arterial blood gases (ABGs), chest radiograph, and electrocardiogram may be required. . Positive end-expiratory pressure (PEEP)-assisted ventilation may be necessary in pa- tients with acute parenchymal injury who develop pulmonary edema or adult respiratory distress syndrome. . Products may cause acidosis; hyperventilation and sodium bicarbonate may be ben- eficia!. Bicarbonate therapy should be guided by patient presentation, ABG determination, and serum electrolyte conSlderations. . Obtain toxicological consultation as necessary.

443 Phosphorus and Related Compounds

SUBSTANCE IDENTIFICATION Found as solids and liquids. In solid form, phosphorous eXlsts as a white-to-yellow, 50ft, waxy substance that spontaneously bums in air. It can be found as a yellow fuming liquido Also found in a red granular fonn Red phosphorous ís relatively nontoxic, sínce it has low volaUhty and is not well absorbed. Used in the manufacture of many products, including fertílizers. water treatment products. food products, and explosíves. Also used in rat poisons and roach powders. Many of these products can spontaneously bum in air. ROUTES OF EXPOSURE Skin and eye contact Inhalation Ingestion Skin absorption TARGET ORGANS Primary Skin Eyes Respiratory system Gastrointestinal system Hepatic Renal Secondary Central nervous system Cardiovascular system Metabolism LlFE THREAT Hypovolemic shock and severe tissue bums. Severe respiratory irritant that can cause pulmonary edema and respiratory arrest. Cardiac rhythm and electrocardiogram changes leading to sudden death have also been reported. SIGNS AND SYMPTOMS BY SYSTEM Cardiovascular: Cardiac arrhythmias and hypovolemic shock. Respiratory: Acute pulmonary edema. which may be delayed. Dyspnea. tachypnea, and irritatíon of the reSplratory tract. CNS: Headache, dizziness, fatigue, and photophobia. May cause seizures and coma. Gastrointestinal: Mucosal bums. Nausea, vomiting, and abdominal pain. Increased salivation with tooth and Jaw pain. Vomitus and feces may be phosphorescent, and the breath may exhibit a garlic odor (all are rare findings). Eye: Lacrimation, eyelid spasm (blepharospasm), conjunctivitis, comeal damage, and photophobia. Skin: Severe chemical and thennal bums. Irritant dermatitis. Renal: Kidney damage, including renal failure. Hepatic: Fatty degeneration of the liver and jaundice. 444 Phosphorus and Related Compounds 109

Metabolism: Hypoglyeemia and hypoealcemia. Other: After initial symptoms, a symptom-free period of several days may oeeur. fol- lowed by signs of severe systemic poisoning. Red phosphorus is less toxic than white or yellow. Although red phosphorous is poorly absorbed and nontoxic in a single dose. repeated doses may demonstrate enhanced absorption. eausmg toxieity. The abllity to detect the product by smell may be lost after a short exposure time (olfactory nerve fatigue). SYMPTOM ONSET FOR ACUTE EXPOSURE Irnmediate Some symptoms. especially respiratory and hepahc. may be de1ayed THERMAL DECOMPOSITION PRODUCTS INCLUDE Hydrogen Hydrogen chloride Phosphine Phosphoric acid fumes Phosphorus oxides MEDICAL CONDITIONS POSSIBLYAGGRAVATED BY EXPOSURE Respiratory disorders (COPD) Liver disorders DECONT AMINATION . Wear positive-pressure SCBA and protective equipment specified by references such as [he DOr Emergency Response Guidebook or [he CANUTEC Inicial Emergency Response Guide. If special chemical protective clothing is required. consult the chemical manufacturer or specific protective c10thing eompatibihty eharts. . Delay entry until trained personnel and proper protective equipment are available. . Remove patient fram contaminated area. . Quicldy remove and isolate patient' s clothing, jewelry, and shoes. . Gently brush away dry partic1es and blot excess liquids with absorbent material. . If phosphorus partlcles are embedded in the skin, continuous water irrigation, water emersion, or sterile water-soaked dressings should be applied during transport to hospital for surgical debridement. Do not use oil for phosphorus exposure because thiS may promote dermal absorption. . Rinse patient with cool water. . Wash patlent with Tincture of Green soap or a mild liquid soap and large quantities of water. . Refer to decontamination protocol in Section Three. IMMEDIATE FIRST AID . Ensure that adequate deeontarnmation has been carried out. . If victim is not breathing, start artificial respiration, preferably with a demand-valve resuscitator. bag-valve-mask device, or pocket mask as trained. Perfonn CPR if necessary. . Irnmediately flush contaminated eyes with gently flowing water. . Do not induce vomiting. If vomiting occurs, lean patient forward or place on left side (head-down position, if possible) to maintain an open airway and prevent aspiration. . Keep victim quiet and maintain normal body temperature. . Obtain medlcal attention.

445 109 Phosphorus and Related Compounds

BASIC TREATMENT

" Estab1ish a patent airway. Suction if necessary. . Watch for signs of respiratory insufficiency and assist ventilations if necessary. . Administer oxygen by nonrebreather mask at 10 to 15 Umin. . Monitor for pulmonary edema and treat if necessary (refer to pulmonary edema protocol in Section Three). . Monitor for shock and treat if necessary (refer to shock protocol in Section Three). . Anticipate seizures and treat if necessary (refer to seizure protocol in Section Three). . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with normal saline during transport (refer to eye irrigation protocol in Sec- tion Three). . Do not use emetics. For ingestion, rinse mouth and administer 5 mllk.g up to 200 mi of water for dilution if the patent can swallow, has a strong gag reflex, and does not drool. Administer activated charcoal (refer to ingestion protocol in Section Three and activated charcoal protocol in Section Four). . If product was ingested, protect yourself from contact with vomitus as it may cause bums. ADVANCED TREATMENT Consider orotracheal or nasotracheal intubation for airway control in the patient who " is unconscious or in respiratory arrest. " Positive-pressure ventilation techniques with a bag-valve-mask device may be benefi- cial. . Monitor cardiac rhythm and treat arrhythmias if necessary (refer to cardiac protocol In Section Three). . Start an IV with DsW TKO. Use lactated Ringer"s if slgns of hypovo1emia are present. Watch for signs oí fluid overload. . Consider drug therapy for pulmonary edema (refer to pulmonary edema protocol in Section Three). . For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload (refer to shock protocol in Section Three). . Treat seizures with diazepam (Valium) (refer to diazepam protocol in Section Four). . Monitor for signs of hypoglycemia (decreased LOC, tachycardia, pallor, dilated pupils, diaphoresis, andJor dextrose stick or glucometer readings below 50 mg/dl) and administer 50% dextrose if necessary. Draw blood sample before administration (refer to 50% dextrose protocol in Section Four). . Use proparacaine hydrochloride to assist eye irrigation (refer to proparacaine hydrochloride protocol in SectlOn Four). (NITIAL EMERGENCY DEPARTMENT CONSIDERATIONS . Useful initiallaboratory studies indude complete blood count, prothrombin time, semm electrolytes, blood urea nitrogen (BUN), creatinine, glucose, unnalysls, and baseline biochemical profile, induding bilirubin, semm arninotransferases (ALT and AST), calcium, phosphorus, and magnesmm. DeterminatlOn of anion and osmolar gaps may be helpful. Arterial blood gases (ABGs), chest radiograph, and e1ectrocar- diogram may be required. . Positive end-expiratory pressure (PEEP)-assisted ventilation may be necessary in pa- tients with acute parenchymal injury who develop pulmonary edema or adult respiratory distress syndrome.

446 Phosphorus and Related Compounds 109

. Calcium supplementation (IV calcium gluconate) may be required to correct hypocal- cemia. Therapy should be guided by chnical presentatíon and laboratory findings. . Obtain toxicological consultation as necessary. SPECIAL CONSIDERATIONS . Products are extremely toxic; rapid transport is essentIal. If solids are embedded in the skin, keep area submerged in water during transport to hospital for surgical debridement. . Three stages of acute phosphorus poisoning: Stage 1: GI symptoms and shock (Oto 24 hours). Stage II: Quiescent period of 1 to 3 days. Stage Ill: Hepatic damage/failure, renal failure, arrhythmias, seizures, and coma.

447