TABLE 1745 ED Management of Hydrocarbon Exposures

The patient needs to be fully undressed to prevent ongoing contamination from hydrocarbon-soaked clothes. Dermal decontamination with soap and water, and eye decontamination with saline irrigation, should be performed. Pre-hospital decontamination is preferable. The staff should wear protective gloves and aprons to prevent possible secondary exposure. Specific antidotal treatment directed at the complications of toxic additives, such as organophosphates or heavy metals, may also be needed.

Useful diagnostic tests include the chest x-ray and arterial blood gas to detect pulmonary aspiration and hypoxemia. Abdominal radiographs may show evidence of chlorinated hydrocarbon ingestions, such as carbon tetrachloride, because of the radiopaque nature of these substances. 23 Tests of liver and renal function should be obtained in all aromatic and halogenated hydrocarbon exposures to check for the development of hepatic and renal injury. A blood lead level may be helpful when evaluating patients with chronic gasoline exposure. A carboxyhemoglobin level is useful to evaluate the extent of endogenous carbon monoxide production following methylene chloride exposure. Pulse oximetry will not differentiate between oxyhemoglobin and carboxyhemoglobin. Routine drug screens are not useful for the detection of hydrocarbons, but as in all intentional ingestions, an acetaminophen level, ethanol level, anion gap, and osmolality may be helpful in assessing for the presence of other coingestants.

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