Ethylene

CAS RN:74-85-1

Treatment Overview

0.4.3 INHALATION EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Primarily supportive care. Supplemental oxygen is the mainstay of treatment, and most patients recover rapidly once exposure ceases and oxygen is administered.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Supportive treatment. Administer supplemental oxygen. In cases of severe CNS depression, consider orotracheal intubation. Anxiety and euphoria are signs of hypoxemia. Avoid benzodiazepines or other respiratory depressant agents. Patients who do not recover rapidly have likely sustained hypoxic end organ damage, which may be irreversible. Cerebral edema with increased intracranial pressure (ICP) may be managed by ventilation and the administration of mannitol; persistent elevation of ICP may require mechanical decompression (eg, decompressive craniectomy).
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Remove the patient from the hypoxic environment as quickly as possible and administer supplemental oxygen.
  • D) AIRWAY MANAGEMENT
    • 1) Early orotracheal intubation in patients with signs of severe poisoning (ie, severe CNS depression, insufficient respiratory effort, seizures).
  • E) ANTIDOTE
    • 1) Oxygen is the antidote for asphyxiant poisoning. Administer high flow oxygen to all symptomatic patients.
  • F) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Patients with minimal symptoms after inadvertent exposure can be managed at home with termination of exposure.
    • 2) OBSERVATION CRITERIA: Symptomatic patients and those with deliberate exposures should be referred to a healthcare facility.
    • 3) ADMISSION CRITERIA: Patients with CNS depression, seizures, or other signs of severe hypoxemia should be admitted to the hospital.
    • 4) CONSULT CRITERIA: Consult a poison control center or a medical toxicologist for assistance in managing patients with severe toxicity (ie, CNS depression, seizures) or in whom the diagnosis is not clear.
  • G) PITFALLS
    • 1) Failure to recognize concurrent toxicity (ie, carbon monoxide or pulmonary irritants), resulting in morbidity from untreated poisoning. Frostbite may occur due to rapid evaporation of some of these agents.
  • H) DIFFERENTIAL DIAGNOSIS
    • 1) Differential diagnosis is wide given the non-specific symptoms and signs in asphyxiant exposure. The hallmark of severe asphyxiant poisoning is CNS dysfunction in conjunction with hypoxemia and low oxygen saturation. History of exposure is the key to diagnosis.
    • 2) Consider carbon monoxide poisoning, methemoglobinemia, poisoning with other CNS depressants, drugs associated with seizures or other CNS affections. Consider cellular asphyxiants (oxygen saturation will be high in patients with cyanide poisoning).
0.4.4 EYE EXPOSURE
  • A) Irrigate exposed eyes with copious amounts of room temperature water for at least 15 minutes.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) Rewarming and a variety of topical treatments are indicated for frostbite injury. SEE MAIN SECTION FOR MORE INFORMATION.
0.4.2 ORAL EXPOSURE
  • A) GASTRIC LAVAGE
    • 1) Significant esophageal or gastrointestinal tract irritation or burns may occur following ingestion. The possible benefit of early removal of some ingested material by cautious gastric lavage must be weighed against potential complications of bleeding or perforation.
    • 2) GASTRIC LAVAGE: Consider after ingestion of a potentially life-threatening amount of poison if it can be performed soon after ingestion (generally within 1 hour). Protect airway by placement in the head down left lateral decubitus position or by endotracheal intubation. Control any seizures first.
      • a) CONTRAINDICATIONS: Loss of airway protective reflexes or decreased level of consciousness in unintubated patients; following ingestion of corrosives; hydrocarbons (high aspiration potential); patients at risk of hemorrhage or gastrointestinal perforation; and trivial or non-toxic ingestion.
  • B) ACTIVATED CHARCOAL
    • 1) Activated charcoal binds most toxic agents and can decrease their systemic absorption if administered soon after ingestion. In general, metals and acids are poorly bound and patients ingesting these materials will not likely benefit from activated charcoal administration.
      • a) Activated charcoal should not be given to patients ingesting strong acidic or basic caustic chemicals. Activated charcoal is also of unproven value in patients ingesting irritant chemicals, where it may obscure endoscopic findings when the procedure is justified.
    • 2) ACTIVATED CHARCOAL: Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
  • C) DILUTION -
    • 1) Immediate dilution with milk or water may be of benefit in caustic or irritant chemical ingestions.
    • 2) DILUTION: If no respiratory compromise is present, administer milk or water as soon as possible after ingestion. Dilution may only be helpful if performed in the first seconds to minutes after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting.
  • D) IRRITATION -
    • 1) Observe patients with ingestion carefully for the possible development of esophageal or gastrointestinal tract irritation or burns. If signs or symptoms of esophageal irritation or burns are present, consider endoscopy to determine the extent of injury.
  • E) OBSERVATION CRITERIA -
    • 1) Carefully observe patients with ingestion exposure for the development of any systemic signs or symptoms and administer symptomatic treatment as necessary.
    • 2) Patients symptomatic following exposure should be observed in a controlled setting until all signs and symptoms have fully resolved.
0.4.3 INHALATION EXPOSURE
  • A) DECONTAMINATION -
    • 1) INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm.
  • B) IRRITATION -
    • 1) Respiratory tract irritation, if severe, can progress to pulmonary edema which may be delayed in onset up to 24 to 72 hours after exposure in some cases.
  • C) ACUTE LUNG INJURY -
    • 1) ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.
  • D) BRONCHOSPASM -
    • 1) If bronchospasm and wheezing occur, consider treatment with inhaled sympathomimetic agents.
  • E) OBSERVATION CRITERIA -
    • 1) Carefully observe patients with inhalation exposure for the development of any systemic signs or symptoms and administer symptomatic treatment as necessary.
    • 2) Patients symptomatic following exposure should be observed in a controlled setting until all signs and symptoms have fully resolved.
0.4.4 EYE EXPOSURE
  • A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) DERMAL DECONTAMINATION -
      • a) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    • 2) PESTICIDES -
      • a) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    • 3) IRRITATION -
      • a) Treat dermal irritation or burns with standard topical therapy. Patients developing dermal hypersensitivity reactions may require treatment with systemic or topical corticosteroids or antihistamines.
    • 4) DERMAL ABSORPTION -
      • a) Some chemicals can produce systemic poisoning by absorption through intact skin. Carefully observe patients with dermal exposure for the development of any systemic signs or symptoms and administer symptomatic treatment as necessary.
Find more information on this substance at: Hazardous Substances Data Bank , TOXNET , PubMed