sodium-hypochlorite and Emergencies

Alkaline ingestion is a potentially life-threatening problem that may confront the emergency physician. It is similar to many other toxins in that children and those who attempt suicide are its most common victims; however, implications in terms of initial stabilization and definitive care are quite distinct. Mucosal exposure to lye results in a quick, deep liquefactive necrosis. Consequently, blind nasotracheal intubation may result in the perforation of damaged tissues in the pharynx and trachea. For similar reasons, the blind passage of a nasogastric tube is contraindicated. The use of diluents in this setting is controversial. If a diluent is used, water and milk are considered the liquids of choice. They may be used to irrigate oropharyngeal burns, but are contraindicated in the face of respiratory compromise, shock, liquid lye ingestion, and perforation of the esophagus or stomach. Cathartics and charcoal are not used after alkaline ingestion. Cathartics, however, are used in miniature alkaline battery ingestions to diminish bowel transit time. Esophagoscopy should be done within 12 to 24 hours after ingestion to directly observe the extent of damage. This procedure should be stopped at the first sign of injury to protect against iatrogenic esophageal perforation. Steroids should be started for circumferential esophageal burns and in those patients with significant injury who are unable to undergo esophagoscopy. IV antibiotics are administered for gastrointestinal perforation and may be used concomitantly with steroids. Miniature alkaline batteries lodged in the esophagus must be removed immediately. The available modalities include fluoroscopy-directed Foley catheter removal, endoscopy, and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Burns, Chemical; Caustics; Charcoal; Child; Child, Preschool; Emergencies; Emetics; Endoscopy; Esophageal Stenosis; Esophagoscopy; First Aid; Gastric Mucosa; Gastroscopy; Household Products; Humans; Infant; Intestinal Mucosa; Lye; Methylprednisolone; Middle Aged; Sodium Hypochlorite; Therapeutic Irrigation

During emergencies in the United States, the Environmental Protection Agency (EPA) currently recommends using bottled water, or boiling or treating water by adding 1/8 teaspoon (or 8 drops) of bleach to 1 gal of water. This bleach recommendation is internally inconsistent, a relatively high chlorine dose (5.55-8.67 mg/L), and unsupported by evidence. In this study, bleach was added in three different dosages to six waters available to emergency-affected populations in each of six states; free chlorine residual (FCR) and Escherichia coli/total coliforms were measured 1-24 h after treatment. Data were analyzed using four efficacy criteria. Results indicated the dosages in the current EPA recommendation are unnecessarily high to ensure (1) maintenance of FCR for 24 h after treatment, (2) absence of E. coli/total coliforms, and (3) establishment of a CT-factor sufficient to inactivate Giardia lamblia and enteric viruses 1 h after treatment. Additionally, emergency-prone populations did not have the materials to complete treatment with bleach in their household. Therefore, we recommend EPA review and revise the current recommendation to establish an internally consistent, criteria-based recommendation that is usable by emergency-affected populations. We also recommend investigating the use of new or commercially available water treatment products for emergency response in the United States.

Topics: Bleaching Agents; Emergencies; Enterobacteriaceae; Enterovirus; Escherichia coli; Giardia lamblia; Humans; Sodium Hypochlorite; United States; United States Environmental Protection Agency; Water Microbiology; Water Purification; Water Quality

Topics: Ammonia; Bronchial Spasm; Chemical Phenomena; Chloramines; Coma; Disinfectants; Emergencies; Fatal Outcome; Female; Heart Arrest; Heart Massage; Household Products; Humans; Hypoxia, Brain; Inhalation Exposure; Middle Aged; Respiratory Insufficiency; Sodium Hypochlorite

Results of treatment of 50 patients with urgent pathology of organs of the abdominal cavity are presented. Indirect electro-chemical detoxication of blood against the background of the antioxidant protection of organism was applied with the purpose of detoxication. The problems of a possible side effect of the indirect electro-chemical detoxication of blood, the optimum dosage of sodium hypochlorite in the intravenous injection were investigated.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Antioxidants; Blood; Disinfectants; Emergencies; Humans; Injections, Intravenous; Lasers; Lipid Peroxidation; Middle Aged; Sodium Hypochlorite

Mass exposure to chloramine gas has not been reported. We report two groups of 36 patients (72 total) suffering from acute inhalation of chloramine gas. Chloramine gas is produced from mixing common household cleaning agents containing sodium hypochlorite (bleach) and ammonia. The first mass casualty event occurred when 36 male soldiers were exposed during a "cleaning party" in their barracks. Ten days later, 36 female soldiers were exposed in a similar manner and presented to our emergency department. In each event, commonly available cleaning agents--liquid bleach and ammonia--were mixed together, liberating toxic chloramine gas. Nebulized sodium bicarbonate solution has been suggested for treatment of chlorine gas inhalation, but no report of nebulized sodium bicarbonate for treatment of chloramine gas inhalation injury exists. In our series, 22 patients exposed to chloramine gas were treated with a nebulized solution of 3.75% sodium bicarbonate. This treatment made no significant statistical or clinical difference in outcome. We present the largest case series of patients presenting to an emergency department for treatment of acute inhalation of chloramine gas.

Topics: Adult; Aerosols; Ammonia; Emergencies; Female; Gas Poisoning; Household Products; Humans; Male; Military Personnel; Sodium Bicarbonate; Sodium Hypochlorite

Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Emergencies; Female; Florida; Humans; Incidence; Male; Middle Aged; Pain, Postoperative; Periapical Periodontitis; Pulpectomy; Pulpitis; Pulpotomy; Root Canal Filling Materials; Root Canal Irrigants; Sex Factors; Sodium Hypochlorite; Tooth; Zinc Oxide-Eugenol Cement