Crude Oil

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Remove the patient from the source of exposure. When a patient is removed from an inhalational exposure, the symptoms should quickly resolve. Adolescents may present without symptoms after responsible adults find them abusing hydrocarbons via inhalation. Provide oxygen and symptomatic and supportive care. After assuring that the patient is medically stable, remove contaminated clothing and wash exposed skin with soap and water.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Orotracheal intubation for airway protection should be performed early if a patient exhibits respiratory distress. Prophylactic antibiotics and steroids are of no proven benefit in hydrocarbon pneumonitis. Animal studies suggest that artificial surfactant via orotracheal tube may be of benefit. Monitor and treat for dysrhythmias.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: GI decontamination is not recommended because of the risk of aspiration. Remove contaminated clothing and wash exposed skin with soap and water.
    • 2) HOSPITAL: Studies fail to show if gastric emptying improves outcomes in patients with oral hydrocarbon ingestions. However, if a patient has ingested a large amount of a hydrocarbon that causes significant systemic toxicity shortly prior to presentation, it is reasonable to insert a small NG tube and aspirate gastric contents. Activated charcoal should NOT be used; it does not adsorb hydrocarbons well and increases the likelihood of vomiting and aspiration.
  • D) AIRWAY MANAGEMENT
    • 1) Perform early in patients with severe intoxication (coma, dysrhythmias, respiratory distress).
  • E) ANTIDOTE
    • 1) None.
  • F) HYPERTHERMIA
    • 1) Consider antipyretics. Evaluate for secondary pneumonia and other infectious causes.
  • G) COMA
    • 1) Treatment is symptomatic and supportive. Perform orotracheal intubation to protect airway. Assess oxygenation, evaluate for hypoglycemia, and consider naloxone if coingestants are possible.
  • H) TACHYCARDIA
    • 1) Tachycardia may occur from a combination of agitation and catecholamine release. Treat with IV fluids and benzodiazepine sedation if agitation is prominent.
  • I) DYSRHYTHMIAS
    • 1) Initiate ACLS protocols. Some solvents appear to sensitize the myocardium to catecholamines. Epinephrine and other sympathomimetics should be used with caution as ventricular dysrhythmias may be precipitated.
  • J) RESPIRATORY DISTRESS
    • 1) Administer oxygen. Intubate early if patient has respiratory symptoms. Consider the use of a surfactant. Endotracheal instillation of 2 doses of 80 mL/m(
    • 2) calfactant (35 mg/mL of phospholipid suspension in saline) in infants, children, and adolescents with acute lung injury resulted in acute improvement in oxygenation and lower mortality in one study.
  • K) RESPIRATORY FAILURE
    • 1) Partial liquid ventilation, high frequency jet ventilation, extracorporeal membrane oxygenation (ECMO) and high frequency chest wall oscillation have all been used with apparent success in cases of severe hydrocarbon pneumonitis.
  • L) ENHANCED ELIMINATION
    • 1) Hemodialysis and hemoperfusion are not of value.
  • M) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Asymptomatic patients with inadvertent exposures may be monitored at home, with particular attention to the development of any respiratory symptoms. Patients who develop symptoms during home monitoring should be referred to a medical facility.
    • 2) OBSERVATION CRITERIA: Patients with deliberate ingestions and symptomatic patients should be sent to a health care facility for observation for 6 to 8 hours. Although patients can develop a delayed pneumonitis, they are unlikely to do so if they have been completely asymptomatic during that time period.
    • 3) ADMISSION CRITERIA: Patients with significant persistent central nervous system toxicity (somnolence, delirium), or respiratory symptoms of cough or tachypnea should be admitted. Patients with coma, dysrhythmias, or respiratory distress should be admitted to an intensive care setting.
    • 4) CONSULT CRITERIA: Consult a poison center or medical toxicologist for assistance in managing patients with severe toxicity (dysrhythmias, coma or respiratory distress), or in whom the diagnosis is not clear.
  • N) PITFALLS
    • 1) Failure to aggressively manage the airway can result in death. Patients with minimal respiratory symptoms may progress to severe toxicity over several hours. Patients with altered mentation should be ruled out for intracranial hemorrhage, infection, metabolic disturbance and other toxicologic causes.
  • O) DIFFERENTIAL DIAGNOSIS
    • 1) Hypoglycemia, central nervous system infection, pulmonary infection, rheumatologic or endocrine etiology, other sedative poisoning (ethanol/benzodiazepine/barbiturate for example), mental illness.
0.4.3 INHALATION EXPOSURE
  • A) 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.
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) 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) 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