Colleen Thomas - A warning to the public - 01/08/11

Colleen Thomas - A warning to the public 01/08/11 - Phosgene (COCl2) is a highly poisonous gas that was first used in combat during World War I. It is no longer used in chemical warfare and the most likely sources of exposure are the manufacture of chemicals that include pharmaceuticals, pesticides, polyurethane and coal tar. Exposure to phosgene also may occur when heating chlorinated compounds, such as carbon tetrachloride, chloroform and methylene chloride.

Instructions:

1 Identify the common symptoms of phosgene poisoning. It is primarily a respiratory irritant that causes coughing with white or yellow sputum, breathing difficulties that become progressively worse and tightness in the chest. Other symptoms include burning in the ears, eyes, nose and throat.

2 Provide immediate first aid. Remove the patient from the suspected source of phosgene gas. Begin irrigating the eyes and skin on site if he has been exposed. Provide standard management of the airway, breathing and circulation.

3 Administer emergency intubation and suctioning for severe cases of phosgene poisoning as in a mass casualty situation. Positive end-expiratory pressure may be needed immediately to maintain the distal airway opening.

4 Use bronchodilators with caution to treat significant bronchospasms. These drugs include ibuprofen, colchicine, terbutaline and many others. Nebulized sodium bicarbonate also may be beneficial but is an alternative to bronchodilators. Administer corticosteroids to reduce the inflammatory response to pulmonary edema.

5 Provide additional treatment for phosgene poisoning in a hospital setting. Initiate oxygen supplementation with high humidity and avoid the administration of excessive fluids unless the patient is hypotensive. Avoid diuretics because the patient is typically volume-depleted.