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- Chemical Treatment Guide: ORANGE

Chemical Treatment Guide: ORANGE
• Hydrofluoric acid (HF)
• Vicane

SIGNS AND SYMPTOMS

Hypovolemic shock and collapse, tachycardia with weak pulse, acute pulmonary edema,
asphyxia, chemical pneumonitis, upper airway obstruction with stridor, pain and cough, decreased
LOC, nausea/vomiting, diarrhea, possible GI bleeding, and possible blindness. HF also causes
severe skin burns. The damage may be severe with no outward signs, except that the patient will
complain of severe pain.

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.
• 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 burns to the eye(s): Immediately flush with copious amounts of water or
normal saline. Prepare an eye wash solution by mixing calcium gluconate (10%) 50 mL in
normal saline 500 mL.
• Apply calcium gluconate eye wash using the Morgan lens (see Medical Procedure 4.45) and
continue until arrival at the receiving facility.
If the patient has burns to the skin for Adult and Pediatric
• Immediately flush with copious amounts of water.
• Prepare a skin gel by mixing calcium gluconate (10%) 10 mL into a 2-oz tube of KY Jelly
(making a 2.5% gel) (b).
• Apply a 2.5% calcium gluconate gel on the burned area. For burns to the hand(s), place the
hand in a glove filled with this gel.

For inhalation injury: For Adult and Pediatric
• Immediately support ventilations.
• Administer calcium gluconate Treat inhalation injuries with oxygen and 2.5% calcium gluconate
nebulizer, administer 1mL mixed 3mL normal saline via a nebulizer.
• For severe respiratory depression/arrest and/or cardiac toxicity (dysrhythmia, prolonged QT
interval, hypotension), administer calcium gluconate (10%) 1-2 g slow IV over 5 minutes.
• Treat dysrhythmias.
• Treat persistent hypotension
• 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.
-If systemic symptoms persist, repeat calcium gluconate (10%) adult dose 1-2 g slow IV over 5
minutes pediatric dose 100mg/kg maximum dose is 1 g IV slow over 5 minutes.

PEARLS
- 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.
- Do not use calcium carbonate, as the outcome can be disastrous.

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