Clinical Practice Guidelines:
Toxicology and toxinology/Corrosive agents
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Date
February, 2015
Purpose
To ensure a consistent approach to the management of Corrosive agents poisoning.
Scope
Applies to all QAS clinical staff.
Author
Clinical Quality & Patient Safety Unit, QAS
Review date
February, 2017
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Corrosive agents
February, 2015
Corrosive agents cause direct injury to the respiratory and
gastrointestinal tract if ingested. Resultant airway compromise can be lethal.
Clinical features
UNCONTROLLED WHEN PRINTED
Respiratory
• hoarse voice
CORROSIVE AGENTS
Acids:
Cause damage via coagulative necrosis. The eschar formation limits the depth of
penetration (excluding hydrofluoric acid).
• dyspnoea
• stridor
Gastrointestinal
UNCONTROLLED WHEN PRINTED
Examples include:
hydrochloric acid, sulfuric acid, hydrofluoric (HF) acid
Alkali:
These cause a liquefactive necrosis resulting in an ongoing deeper penetration despite an
initial benign appearance.
• oral burns
• drooling
• painful swallowing
• vomiting
• abdominal pain
UNCONTROLLED WHEN PRINTED
Examples include:
sodium hydroxide, potassium hydroxide,
ammonia, sodium hypochlorite
Other:
zinc chloride, mercuric chloride, glyphosate,
phenols, potassium permanganate, disc button batteries
Risk assessment
High risk features for airway compromise:
• Hoarse voice
• Dyspnoea
• Stridor
UNCONTROLLED WHEN PRINTED
Figure 2.69
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e
CPG: Paramedic Safety
Additional information
CPG: Standard Cares
• The absence of oral burns does not exclude significant
gastrointestinal injury.[1]
UNCONTROLLED WHEN PRINTED
• High index of suspicion for ophthalmic injury.
• Do not place an OGT in the pre-hospital setting given the potential for gastrointestinal mucosal injury.
• Hydrofluoric acid exposure is life-threatening, even after seemingly minor quantities.[2]
Consider safety issues and decontamination
• Rinse patient mouth with water
• Do not encourage vomiting
UNCONTROLLED WHEN PRINTED
- Fluoride binds calcium and magnesium, precipitating
intractable ventricular arrhythmias and death.
- Follow first-aid instructions provided at industrial
sites (e.g. application of calcium gluconate gel)
- Transport without delay and pre-notify.
• Any disc button battery with residual voltage can cause
tissue damage.[3]
Consider:
Oxygen
IPPV
IV access
Analgesia
Calcium
Calcium gluconate
gluconate neb
neb (HF
(HF inhalation
inhalation only)
only)
• Antiemetic
• IV fluid
••
•
•
•
••
UNCONTROLLED WHEN PRINTED
• 12% of children who ingested a 20 mm battery suffered severe or fatal injuries.[3]
UNCONTROLLED WHEN PRINTED
Note: Officers are only to perform procedures
for which they have received specific training
and authorisation by the QAS.
Transport to hospital
Pre-notify as appropriate
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