Ronald Chrisbianto Gani405090223

Faculty of MedicineTarumanagara University

EMERGENCY MEDICINE BLOCK

HYDROCARBON POISONING

HYDROCARBON POISONING

Rosen’s Emergency Medicine 7th Ed

PATHOPHYSIOLOGY

• Three main target organs– Lungs, CNS, Heart

• Cause most damage via lungs• Charactristics– Lower the viscocity, higher the toxicity– High volatility, enable to displace alveolar oxygen– Low surface tension, susbtance disperse easily– Chemical side chains often increase toxicity

Rosen’s Emergency Medicine 7th Ed

PATHOPHYSIOLOGY

• Lung– Bronchospasm and inflammation– Displace oxygen in alveolar hypoxia– Direct injury to pulmonary alveoli and cappilaries

distict uniform lesion– Inhibit surfactant function alveolar collapse

• CNS – Depression– Respiratory pulmonary alveoli blood and tissue

euporia, disinhibiton, confusion, obtudantion

Rosen’s Emergency Medicine 7th Ed

PATHOPHYSIOLOGY

– Chronic use peripheral neuropathy, cerebelar degeneration, neuropsychiatric disorders, chronic encephalopathy, dementia

• Cardiac– Sudden death– Myocardial sensitization ventricular dysrhytmia

and myocardial dysfunction

Rosen’s Emergency Medicine 7th Ed

CLINICAL FEATURES

• Child ingest unknown amount of HC– Cyanosis, coughing, grunting, noisy respirations,

repeated bouts of vomit– Tachypnea, dyspnea, bronchospasm, wheezing,

rales, fever– Change in mental status– Extreme : respiratory failure

Rosen’s Emergency Medicine 7th Ed

CLINICAL FEATURES

• Solvent-abuse adolescent or adult– Cardiac arrest– CNS intoxication (euphoria, agitation,

hallucinations, confusion, bizzare behavior) CNS depression and seizure

– Long term : peripheral neuropathy, cerebelar degeneratio, encephalopathy

Rosen’s Emergency Medicine 7th Ed

CLINICAL FEATURES

• Accidental dermal or inhaled respiratory exposure– Not life-threathening– Asymptomatic or transient symptoms (headache,

dizziness, nausea)– Skin : erythema, swelling, blistering, dermal

destruction

Rosen’s Emergency Medicine 7th Ed

DIAGNOSIS

• History and PE for aspiration• Significant HC exposure (tachypnea,

tachycardia, wheezing, hypoxemia) chest radiograph

• Continuous pulse oxymetri and ABG• Chronic users behavioral problems

exclude underlying disease

Rosen’s Emergency Medicine 7th Ed

CXR

Rosen’s Emergency Medicine 7th Ed

MANAGEMENT

• All patients must be monitored by cardiac monitors and pulse oxymetri

• Intubation needed in severe cases• High frequency jet ventilation and exreacorporeal

membrane oygenation children with respiratory failure secondary to aspiration

• Surfactant therapy • Supportive care and close observation, no specific

antidotes

Rosen’s Emergency Medicine 7th Ed