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Toxic gases and aerosols 

Toxic gases and aerosols

Chapter:
Toxic gases and aerosols
Author(s):

D.J. Hendrick

DOI:
10.1093/med/9780199204854.003.181411

July 30, 2015: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 27 April 2017

Acute exposure—the effects of noxious gases or aerosols on the airways and lungs are determined by (1) their solubility in water, with those that are highly soluble having their main effect on the lining of the upper respiratory tract and those with lower solubility mainly affecting the lungs, and (2) the dose of exposure, with overwhelming exposures having adverse effects throughout the respiratory tract.

Clinical features—acute effects are usually the result of industrial or farming accidents and comprise (1) acute upper airway toxicity—caused by highly soluble gases (e.g. ammonia, sulphur dioxide); laryngeal oedema may be severe enough to cause airflow obstruction and require intubation; (2) acute tracheobronchitis—usually caused by less soluble gases at less pungent levels of exposure (e.g. chlorine); full recovery is expected if the patient survives, but some are left with the reactive airways dysfunction syndrome; (3) acute pneumonitis—caused by gases of low solubility (e.g. nitrogen dioxide—silo filler’s disease); produces acute pneumonitis and pulmonary oedema some hours after exposure; (4) asphyxiation—some inhaled gases, most commonly CO2 and methane, have no toxic effects but may cause death through asphyxiation by displacing oxygen from inhaled air.

Management—this is essentially supportive. While ensuring the safety of potential rescuers, prompt removal from the source of exposure (and from any toxic agent that contaminates clothing and/or lies on the skin) is followed by attention to airway patency, oxygenation and swift transportation to specialized emergency care.

Subacute exposure—working exposures over weeks/months to a few chemical agents are recognized to cause a variety of additional airway and interstitial effects.

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