MANAGEMENT OF EXPOSURE TO HYDROGEN FLOURIDE OR HF

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MANAGEMENT OF EXPOSURE TO HYDROGEN FLOURIDE OR HF

• PRESENTED BY
• Miguel Trevino, M.D.
• Occupational Medicine
• U.de M - U.C.S.C - FACOEM
• MRO

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GENERAL INFORMATION ABOUT HF
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USES OF HF

• ELECTRONICS.- Production of microchips,
  electronic circuit cleaners.
• METALURGY.- Metal pickling/Aluminum manufacture
• PETRO CHEMICALS.- As a catalyst in the
  alkalization of gasoline.
• GLASS INDUSTRY. Glass edging.
• REFRIGERENT GASES.- For automotive, air
  conditioning, refrigerator home/industry.
• FIRE EXTINGUISHERS.- Fluorocarbons.

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USES OF HF

• FLUOROCHEMICALS.- Fluorinated Salts Production.
• ANTIADHERENTS.- Production of Teflon.
• MEDICINE.- Propellants for medication, anesthetic
  gases, antibiotic production, production and
  finishes of surgical prosthesis.
• NUCLEAR INDUSTRY.- Purification of uranium ore.
• AGROCHEMICALS. Pesticides.
• CLEANING SOLUTIONS. Rust removers.

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PHYSICAL CHEMICAL PROPERTIES

• FREEZING POINT -118ºF -83ºC
• VAPOR DENSITY 3.0 AT 25ºC
• SPECIFIC GRAVITY (2514) 0.97
• VAPOR PRESSURE AT 20ºC 775MM Hg

• BOILING POINT 67ºF 19ºC

• VOLATILITY 100

• SOLUBILITY IN WATER 100

• ODOR PUNGENT IRRITATING
• PHYSICAL STATE GAS
• DISSOCIATION K3.5 x 10-4

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PHYSIOPATHOLOGY OF EXPOSURES KNOWN TOXICOLOGY
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• HF
• ?
• //////////////////

TISSUE
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ENTRY ROUTES

• SKIN
• RESPIRATORY TRACT
• EYES
• GASTRO-INTESTINAL

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TYPES OF EXPOSURE

• LIQUID EXPOSURE (SPLASH BURN).
• GAS EXPOSURE (INHALATION, SKIN EYES).
• LIQUID GAS (MIXED EXPOSURE).
• LOW CONCENTRATION HF SOLUTIONS.

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Once ionized, the fluoride creates two types of
salts

• INSOLUBLE SALTS
• F Ca ( ) Ca F(2) Calcium Fluoride
• F Mg( ) Mg F Magnesium Fluoride
• This can lead to Hypoglycemia that in turn
• can lead to Cardio Respiratory Arrest,
• Hypomagnesaemia, Na (Sodium) and K
• (Potassium) alterations.

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• SOLUBLE SALTS
• F Na() Na F Sodium Fluoride
• F K() KF Potassium Fluoride
• Which target
• The Kidneys Nefro - Toxic
• The Liver Liver - Toxic
• And are the cause of Acute Fluoride
  Intoxication if sufficient quantities are
  created.

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SO, WHY IS HF A HAZARDOUS MATERIAL?

• It is a Corrosive. (Acid)
• It is a Poison. (Toxic)
• It is an Inhalation Hazard.

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INTRINSIC PROCESS RISK FACTORS IN RELATION TO HF
CHEMICAL FACTORS CHEMICAL FACTORS CHEMICAL FACTORS
PHOSGENE CYLINDERS 200
HCN RAILROAD TANK 10
H2S PRESSURIZED TANK 10
C12 RAILROAD TANK 9
SO2 IN CYLINDER 8
AHC1 ROAD TANK 2.5
AHF IN A RAILROAD TANKER 1
Br2 PRESSURIZED TANK 0.80
SO3 PRESSURIZED TANK 0.60
NH3 NORMAL ATM CONDITIONS 0.30
OLEU PRESSURIZED TANK 0.20
NH3 AT 33ºC 0.09
MMA TANK 0.05
Br2 NORMAL ATM CONDITIONS 0.05
POC13 PRESSURIZED TANK 0.04
RISK FACTORS IN RELATION TO HF WHEN HF 1.0 RISK FACTORS IN RELATION TO HF WHEN HF 1.0 RISK FACTORS IN RELATION TO HF WHEN HF 1.0
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KNOWN TOXICOLOGY

• Acute Corrosive Effects (Burns)
• Acute Fluoride Intoxication
• Sub-Acute Impaired Breathing (hours after)
• Delayed appearance of skin injury (hours after)
• Chronic or Long Term
• Injury to tissue due to corrosive and toxic
  effects. No other effects documented or
  reported. Possible Fluorosis after chronic
  exposure to low concentrations of HF.

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KNOWN TOXICOLOGY

• Reproductive Developmental
• None described or found
• Immuno-Toxicity
• None described or found
• Cancer Forming
• No human reports or studies
• Cardiac Muscular Toxicity
• Yes, due to Fluoride binding to Calcium,
• and Magnesium.

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KNOWN TOXICOLOGY

• Hepatic Nefro Toxicity
• Yes, due to creation of Sodium
• Fluoride and Potassium Fluoride
• after exposure (untreated).

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KNOWN TOXICOLOGY

• TWA
• Time weighted average concentration for a
  normal 8 hour workday and a 40 hour work week to
  which nearly all workers may be repeatedly
  exposed, day after day, without
  adverse effects for all of their
  working life 3PPM (ACGIH).

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KNOWN TOXICOLOGY

• IDLH 30 ppm
• Immediately dangerous to life and health
• (NIOSH).

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KNOWN TOXICOLOGY

• ERPG 1 5 ppm
• The maximum airborne concentration
  below which it is believed that nearly all
  individuals could be exposed for up to 1 hour
  without experiencing other than mild, transient
• adverse health effects or without perceiving
  a clearly defined objectionable odor.

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KNOWN TOXICOLOGY

• ERPG 2 20 ppm
• The maximum airborne concentration
  below which it is believed that nearly all
  individuals could be exposed for up to 1 hour
  without experiencing or developing irreversible
• or other serious health effects or symptoms
  which could impair an individuals ability to
  take protective action.

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KNOWN TOXICOLOGY

• ERPG 3 50 ppm
• The maximum airborne concentration
  below which it is believed that nearly all
  individuals could be exposed for up to an hour
  without experiencing or developing life-
  threatening health effects.

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PRIMARY DECONTAMINATION PROCEDURES
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DECONTAMINATION PROCEDURES

• GO TO THE NEAREST FUNCTIONAL DECON UNIT.
• OPEN THE WATER VALVE.
• TAKE OFF ALL CLOTHING, SHOES JEWELRY.
• REMOVE GOGGLES LAST, FACE THE WATER FLOW, CLOSE
  YOUR EYES, PULL GOGGLES OVER YOUR HEAD.
• REMEMBER, MAXIMUM TIME UNDER SHOWER IS 5 MINUTES.
• This is a Dilution Technique.

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TRIAGE
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PRIMARY TRIAGE

• 1ST To Go Many Signs Symptoms of Exposure
• 2nd To Go Signs and Symptoms Present and
• Possible Systematic
  Effects in Near
• Future
• 3rd To Go Minor or No Signs Symptoms
• Do Not Go Fatalities

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SUGGESTED TREATMENT THROUGH HISTORY

• WASH COPIOUSLY WITH WATER FOR 15 MINUTES.
• SODIUM BICARBONATE SOLUTIONS
• MAGNESIUM SULFATE PASTE.
• MAGNESIUM OXIDE PASTE.
• AMMONIA SOLUTIONS INHALANT.
• HYAMINE SOLUTIONS 0.2 (2 gm BENZEHTONIUM
  CHLORIDE IN 1 LITER OF ICE WATER).

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SUGGESTED TREATMENT THROUGH HISTORY

• ZEPHIRAN 0.13 (1.3 gm BENZALKONIUM CHLORIDE IN 1
  LITER OF ICE WATER).
• CALCIUM GLUCONATE SOLUTIONS 10, 5, 2.5, 1
• CALCIUM GLUCONATE GEL 2.5.
• CALCIUM ACETATE SOLUTIONS.
• ORAL CALCIUM MAGNESIUM BASED ANTACIDS AND
  SOLUTIONS.

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SUGGESTED TREATMENT THROUGH HISTORY

• INTR-ARTERIAL CALCIUM TECHNIQUE (BOLUS AND SLOW
  INFUSION).
• INTRA-VENOUS CALCIUM TECHNIQUE (BIEAR BLOCK).
• HEXAFLUORINE RINSING SOLUTION.
• DMSO CALCIUM GLUCONATE SOLUTION.

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FIRST AID PROCEDURES
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FIRST AID SKIN EXPOSURE

• MINOR BURNS
• Burns smaller than 2 square inches of body
• surface, such as small droplets, or very
  small
• skin burns, low concentration gas or solution
• exposures.
• MAJOR BURNS
• Burns larger than 2 square inches with A.H.F.

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AFTER DECONTAMINATION

• Initiate calcium gluconate 2.5 gel inunction.
  Note the time you start this step.
• Obtain medical attention (call).
• If pain does not subside in 20-30 minutes, go to
  medical treatment.

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FIRST AID EYES

• ALL EXPOSURES ARE CONSIDERED SEVERE.
• DECON
• USE EYEWASH, A GLASS OR LOW PRESSURE WATER HOSE.
  MAXIMUM TIME IS 5 MINUTES.
• IRRIGATE 500cc to 1000cc OF A 1 CALCIUM
  GLUCONATE SOLUTION IN NORMAL SALINE PER EYE.

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FIRST AID EYES

• SEEK SPECIALIZED MEDICAL ATTENTION IMMEDIATELY.
  USE CALCIUM GLUCONATE AT 1 CONCENTRATION UNTIL
  MEDICAL HELP IS REACHED.
• IF THERE IS SKIN EXPOSURE, ALSO FOLLOW SKIN
  DECONTAMINATION AND FIRST-AID PROCEDURES.

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FIRST AID INHALATION

• DECON
• ADMINISTER OXYGEN AT 12 LTS. PER MINUTE.
• START NEBULIZING A 2.5 SOLUTION OF CALCIUM
  GLUCONATE IN NORMAL SALINE, USING A STANDARD
  NEBULIZER OR ULTRA NEBULIZER. PREFERABLY NOSE
  AND MOUTH MASK AND ¾ IN. TUBING
• OBTAIN MEDICAL ASSISTANCE.

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FIRST AID INGESTION

• CONCIOUS PATIENT
• GIVE ORALLY HIGH AMOUNTS OF ANY CALCIUM OR
  MAGNESIUM BASED ANTACID, EFFERVESCENT CALCIUM IN
  WATER, MILK OR WATER.
• DO NOT INDUCE VOMITING!
• UNCONCIOUS PATIENT
• OBTAIN MEDICAL ASSISTANCE IMMEDIATELY.
• DO NOT FORGET TO DECONTAMINATE SKIN OR EYES IF
  THEY WERE EXPOSED.

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SECONDARY DECONTAMINATION PROCEDURES
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SECONDARY DECONTAMINATION

• EXAMINE DECONTAMINATE
• -EAR CANALS
• -MOUTH
• -NOSE
• -ANUS
• -VAGINA
• EXAMINE DECONTAMINATE SKIN FOLDS
• -NECK

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SECONDARY DECONTAMINATION

• -AXILARY REGIONS
• -SUB-MAMMARIAN FOLDS
• -GROIN
• -BEHIND THE KNEES
• -INTER-DIGITAL FOLDS
• EXAMINE DECONTAMINATE BELOW THE NAILS OF
• -HANDS
• -FEET

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SECONDARY DECONTAMINATION

• EXAMINE DECONTAMINATE AREAS COVERED WITH HAIR
• -SCALP
• -PUBIS
• -OTHER AREAS AS NEEDED

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ELECTROCARDIOGRAPHIC EFFECTS

• PROLONGED Q-T INTERVAL
• (DUE TO HYPOCALCEMIA).
• NORMAL SERUM CALCIUM LEVELS
• 2.25 TO 2.6 mmol/lt
• 9 TO 10.5 mg/dl

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MEDICAL TREATMENT PROCEDURES
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FLUORIDE IN SERUM OR IN URINE

• CLINICALLY- THE BEST INDICATOR IS URINE
  FLUORIDES. EASY TO DO, RESULTS IN MINUTES AND
  DEPENDABLE .
• FLUORIDES IN SERUM ARE NOT RELIABLE INDICATORS
  BECAUSE IT DOES NOT PROVIDE A GOOD MEASURE OF
  EXPOSURE TO FLUORIDES, AND IS COMPLICATED TO
  PERFORM, MAY TAKE DAYS BEFORE REPORTED.

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LONG TERM EFFECTS

• FIRST
• SEQUELA NORMALLY ARE ESTABLISHED IN THE
  SUB-ACUTE TIME PERIOD AFTER EXPOSURE AND ARE
  NORMALLY STABLE, SUCH AS
• SKIN HYPO-PIGMENTATION
• KELOID SCARING
• DEEP SEATED SCARING
• SURGICAL SCARS
• NEUROLOGIC, LIVER AND KIDNEY
• DISFUNCTION MAY PERSIST IF DAMAGE IS
• SEVERE.

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LONG TERM EFFECTS

• SECOND
• THE FOLLOWING HAVE NOT BEEN OBSERVED
• HYPER-REACTIVE AIRWAYS
• KIDNEY, LIVER OR CNS DYSFUNCTION
• CANCER
• REPRODUCTIVE PROBLEMS, ETC
• (SEE TOXICOLOGY)

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CALCIUM GLUCONATE AS THE TREATMENT OF CHOICE
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WHY ?

• EASY TO USE.
• CAN BE USED IN FIRST AID MEDICAL
• TREATMENT.
• CAN BE USED TOPICALLY, INFILTRATED,
• INHALED, OPTHAMICALLY AND
• INTRAVENOUSLY.
• NO SOPHISTICATED MEDICAL EQUIPMENT
• REQUIRED, SUCH AS ARTERIAL CATHETERS,
• IV INFUSERS, ETC.

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• EASY TO PREPARE IN GEL FORM OR
• SOLUTIONS.
• TREATMENT IS FAST AND EFFECTIVE.
• THE RESULTING REACTION CHEMICAL
• IS PRIMARILY GLUCOSE AS COMPARED
• TO AMMONIUM FLUORIDE ACETIC
• ACID, IN THE CASE OD AMMONIA
• COMPOUNDS OR CALCIUM ACETATE,
• RESPECTIVELY.

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• CALCIUM IS MUCH MORE FAVORED TO BIND
• WITH FLUORIDE IN THE BODY.
• NONE OR MINOR TISSUE IRRITATION AT
• DESCRIBED CONCENTRATIONS.
• EXCELLENT RESULTS IN BOTH HIGH LOW
• CONCENTRATION EXPOSURES OF HF.
• NO SECONDARY EFFECTS AT THERAPEUTIC
• LEVELS.
• NO NEED FOR SOAKING OR COOLING WITH
• RESULTING HYPOTHERMIC OR VASCULAR
• RISKS.

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IT IS AN EXCELLENT OUTSIDE SOURCE OF CALCIUM
THAT WILL BIND THE FLUORIDE, AND IN DOING SO,
WILL HELP AVOID HYPOCALCEMIA, AND THE CREATION
OF TOXIC COMPOUND IN THE BODY.CAN BE USED
IN THE PRODUCTION FIELD, IN TRANSPORTATION
INCIDENTS AND IN HOSPITALS.
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ALGORITHMS FOR EMERGENCY MEDICAL PROCEDURES FOR
HYDROFLUORIC ACID EXPOSURE
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Respiratory Exposure

• Decontamination Procedures.
• Not Possible
• If gaseous exposure occurs skin and eye
  decontamination
• is necessary.

DECON
Minor Exposure
Major Exposure

• Signs Symptoms.
• Coughing
• Labored Breathing.
• Shortness of Breath
• Erithema
• Swelling
• Bleeding
• Upper Airway Edema.
• Pulmonary Edema.
• Cardiac Arrithmia. (Irregular heart beats).

• Signs Symptoms.
• No signs symptoms.
• Minor coughing.
• Minor swelling and Eritlema.

SIGNS SYMPTOMS

• First-Aid Procedures.
• Administer O2 at a rate of 12 Lts./min.
• Nebulize calcium gluconate 2.5 in
• normal saline for 15 to 20 min.
• Obtain Medical Evaluation and
• observe.

• First-Aid Procedures.
• Administer O2 at a rate of 12 lts./min.
• Continuously nebulize calcium
• gluconate 2.5 in normal saline until
• medically evaluated.
• If respiratory assistance is needed -
• use indirect methods - (Bag-micro-
• shield).-

FIRST-AID

• Medical Treatment Procedures.-
• Respiratory Track Systemic Toxicity.
• Air Way Breathing must be secured. Evaluate
  ABC and
• follow ACLS procedures.
• Positive Pressure Assistance and Positive end
  expiratory
• pressure (peep). Are necessary.- until edema has
  resolved.
• Evaluate and monitor.- Chest x Rays, Blood
  Gases, ECG,
• Electrolytes with special interest in Ca, Mg, Na,
  and K, Blood
• Chemistry, fluorides in urine and blood, liver
  Kidney functions.
• Start IV drip of 1000 cc in normal seline. 20 cc
  of 10 Calcium
• Gluconate.
• The amount of the solution will depend on the
  levels of serum
• calcium.
• Consider Hemodialisis for the removal of serum
  Fluorides.-

MEDICAL TREATMENT
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Respiratory Exposure

• Decontamination Procedures.
• Not Possible
• If gaseous exposure occurs skin and eye
  decontamination
• is necessary.

DECON
Minor Exposure
Major Exposure

• Signs Symptoms.
• Coughing
• Labored Breathing.
• Shortness of Breath
• Erithema
• Swelling
• Bleeding
• Upper Airway Edema.
• Pulmonary Edema.
• Cardiac Arrithmia. (Irregular heart beats).

• Signs Symptoms.
• No signs symptoms.
• Minor coughing.
• Minor swelling and Eritlema.

SIGNS SYMPTOMS
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Eye Exposure

• Decontamination Procedure.
• Go to the nearest water source or eye wash.
• Open the valve.
• Mechanically maintain eye lids open, or ask for
  help.
• Wash for five minutes (5) and no more.

DECON
Major Exposure
Minor Exposure

• Signs Symptoms.
• Irritation of conjunctiva layer and
• eye lid skin (minor).
• Conjuctival injection.
• No evidence of corneal injury.
• No vision loss.

• Signs Symptoms.
• Severe irritation of the conjunctival
• eye, and skin burn to eye lids.-
• Conjuctival injection and swelling.
• Corneal Opacification or Pitting.
• Vision loss.

SIGNS SYMPTOMS
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• First-Aid Procedures.
• Irrigate eyes with a 1 calcium
• gluconate solution in normal
• saline 1000 cc per eye (15 min. Aprox.).-
• The use of an irrigating system
• (Morgan Lens) after using a local
• eye anesthetic (one or two drops
• per eye)
• should be considered.
• Specialized Medical Evaluation
• should be done (Slit lamp, etc).

• First-Aid Procedures.
• Irrigate eyes with a 1 Calcium
• gluconate solution in normal saline
• 1000 cc per eye (15 min. aprox.).
• The use of an irrigating system
• (Morgan Lens) after using a local eye
• anesthetic (one or two drops per eye)
• should be considered.
• Obtain specialized medical evaluation.

FIRST-AID

• Medical Treatment Procedures.-
• If necessary continue treatment with a 1
  solution of calcium
• gluconate in normal saline.-
• Antibiotics and steroids can be used as indicated
  by eye
• specialist.
• Monitor ocular pressure.
• Evaluate corneal opacification regularly.-
• If skin, ingestion or inhalation exposure occurs
  do not forget to
• decontaminate, and follow systemic toxicity
  treatment protocols.
• Psychological support may be necessary.

MEDICAL TREATMENT
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Ingestion

• Decontamination Procedures.
• Not Possible
• If skin or eyes have been exposed decontamination
• procedures should be followed.

DECON
Minor Exposure
Major Exposure

• Signs Symptoms.
• Erithema of oral mucousa.
• Oral injury.
• Bleeding of the oral cavity.
• Systemic Toxicity.
• Possible bronchial or pulmonary
• problems if the patient vomited.

SIGNS SYMPTOMS
ALL EXPOSURES ARE CONSIDERED MAJOR.

• First-Aid Procedures.
• Do Not induce Vomiting.
• If patient is able to swallow give oral
• calcium solutions - or - calcium based
• antacids - milk or water.
• If unconscious obtain Medical Attention
  Immediately

FIRST-AID

• Medical Treatment Procedures.-
• HF destroys fiber optics - consider before using
  endoscopic
• techniques.
• Establish IV drip 1000 cc Normal Saline 20cc -
  10 calcium
• gluconate.
• If possible install a naso-gastric or
  oral-gastric tube.
• Gastric Lavage with calcium solutions, calcium or
  magnesium
• based antacids.
• Systemic Toxicity Control.
• The amount of calcium or magnesium to be
  administed will
• depend on the serum levels.
• Monitor ECG, Electrolytes, with special interest
  on Ca, Mg, K,
• and Na, Chest X Rays may be necessary, blood
  gases, blood
• Chemistry, Kidney and Liver functions.
• Follow ACLS ATLS procedures.
• Consider Hemodialisis for the removal of
  fluorides in Blood.

MEDICAL TREATMENT
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Ingestion

• Decontamination Procedures.
• Not Possible
• If skin or eyes have been exposed decontamination
• procedures should be followed.

DECON
Major Exposure
Minor Exposure

• Signs Symptoms.
• Erithema of oral mucousa.
• Oral injury.
• Bleeding of the oral cavity.
• Systemic Toxicity.
• Possible bronchial or pulmonary
• problems if the patient vomited.

ALL EXPOSURES ARE CONSIDERED MAJOR.
SIGNS SYMPTOMS
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• First-Aid Procedures.
• Do Not induce Vomiting.
• If patient is able to swallow give oral
• calcium solutions - or - calcium based
• antacids - milk or water.
• If unconscious obtain Medical Attention
  Immediately

FIRST-AID

• Medical Treatment Procedures.-
• HF destroys fiber optics - consider before using
  endoscopic
• techniques.
• Establish IV drip 1000 cc Normal Saline 20cc -
  10 calcium
• gluconate.
• If possible install a naso-gastric or
  oral-gastric tube.
• Gastric Lavage with calcium solutions, calcium or
  magnesium
• based antacids.
• Systemic Toxicity Control.
• The amount of calcium or magnesium to be
  administed will
• depend on the serum levels.
• Monitor ECG, Electrolytes, with special interest
  on Ca, Mg, K,
• and Na, Chest X Rays may be necessary, blood
  gases, blood
• Chemistry, Kidney and Liver functions.
• Follow ACLS ATLS procedures.
• Consider Hemodialisis for the removal of
  fluorides in Blood.

MEDICAL TREATMENT
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PATIENTS PROGNOSIS LONG-TERM EFFECTS WILL
DEPEND UPON

• EXPOSURE TIME.
• DECONTAMINATION
• ROUTE OF ENTRY
• CONCENTRATION OF HF.
• TYPE OF TREATMENT GIVEN
• HOW FAST TREATMENT WAS GIVEN.
• GENERAL STATE OF THE PATIENT.
• IF THE TREATMENT IS OPPORTUNE AND
• ADEQUATE, PROGNOSIS WILL BE GOOD IN
• MOST CASES.

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MEDICATION DRESSING MATERIALS THAT SHOULD
EXIST WHEREVER HF IS HANDLED
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1. IN THE FIELD
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• DECONTAMINATION UNITS CONSIST OF
• vSAFETY SHOWER
• vEYEWASH
• vSEALED BOX WITH
• PAIRS OF GLOVES
• 2 TUBES OF HF GEL 30 GRAMS EACH
• 1 ALUMINIZED PLASTIC SHEET

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2. IN AN AMBULANCE, MEDICAL AREAS, OR ANY
WHERE MEDICALLY TRAINED PROFESSIONALS ARE
AVAILABLE
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• ALUMINIZED PLASTIC SHEETS
• HF GEL 2.5
• EYE IRRIGATION SOLUTION 1
• NEBULIZING SOLUTION 2.5
• 5 CALCIUM GLUCONATE AMPS
• NORMAL SALINE IV SOLUTION
• WATER SOLUBLE LUBRICANT GEL
• LOCAL OPTHAMALIC ANESTHETIC
• GLOVES LATEX, PVC OR NEOPRENE
• HYPODERMICS, SEVERAL SIZES CALIBERS, STAINLESS
  STEEL NEEDLES
• MORGAN LENS

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• MORGAN LENS DELIVERY SYSTEM (Y)
• IV DELIVERY SYSTEMS
• COLD PACKS
• TRACHEOSTOMY KIT
• WELL STOCKED EMERGENCY CART
• DEFIB / MONITOR UNIT
• INHALATION THERAPY EQUIPMENT
• NEBULIZERS
• MINOR SURGICAL KIT
• CALCIUM EFFERVESCENT TABLETS
• DRESSING MATERIALS

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3. HYDROFLUORIC ACID KIT
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• ?SHOULD BE IN CONTROL ROOMS OR WELL
• CONTROLLED AREAS. THEY ARE COMPOSED OF
• TWO MAIN PARTS
• INHALATION THERAPY UNIT O(2) CYLINDER
• VALVE, FLOWMETER PRESSURE METER
• NEBULIZER, TUBING MASK.
• ONE PORTABLE CONTAINER THAT CONTAINS
• 4 PAIRSOF GLOVES LATEX, PVC, NEOPRENE
• 1 FLASHLIGHT
• 1 LITER OF 1 CALCIUM SOLUTION IN
• NORMAL SALINE

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• 1 LITER OF 2.5 CALCIUM SOLUTION IN
• NORMAL SALINE
• 8 TUBES OF HF GEL, 2.5
• 5 AMP OF CALCIUM GLUCONATE, 10 SOL
• 5 NEEDLES, 25 CAL 1 ½ LONG, STAINLESS
• STEEL
• 20 STERILE GAUZE
• 2 TOURNIQUETS
• 2 IV TUBING SETS
• 4 BOTTLES OF ANTACID (CALCIUM OR
• MAGNESIUM BASED)

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• 2 IV TUBING SETS
• 4 BOTTLES OF ANTACID (CALCIUM OR
• MAGNESIUM BASED)
• 1 BOTTLE OF EFFERVESCENT CALCIUM
• TABLETS
• 1 BOTTLE OF LOCAL EYE ANESTHETIC
• 2 COLD PACKS
• 2 MAYO CANULAS
• 2 ALUMINIZED PLATIC SHEETS
• 1 TUBE OF LUBRICATING GEL
• 2 STERILE CONTAINERS
• 1 IV INFUSOR
• 4 MORGAN LENSES

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KEYS TO GOOD CONTROL WITH HF

• AVOID EXPOSURES THROUGH
• CONTINUOUS EDUCATION.
• GOOD INDUSTRIAL HYGIENE PRACTICES.
• MAXIMUM SAFETY IN HANDLING HF ON OFF-SITE.
• CONTINOUS MEDICAL TRAINING ON OFF-SITE.
• PARTICIPATE IN NEIGHBORING COMMUNITY HOSPITALS,
  EMS, AND OTHER AGENCIES, SO THAT YOU MAY BE
  PREPARED FOR ANY CONTIGENCY.

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SO , PRODUCE, STORE, HANDLE AND DISPOUSE ALL
HAZARDOUS CHEMICALS WITH RESPECT AND KNOWLEDGE
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FOR YOUR ATTENTION AND PATIENCE THANK YOU VERY
MUCH !!!