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A hazardous chemical is defined by the U.S. Occupational Safety and Health Administration as any chemical that has been shown scientifically to be a health hazard (causes acute or chronic health effects) or a physical hazard (combustible liquid, explosive, flammable, etc.). This federal agency estimates that there are 575,000 chemicals in the workplace, with 53,000 being potentially hazardous.1 Considering that unplanned exposures and contamination can occur at any time during manufacturing, transport, storage, usage, or disposal of these chemicals, inevitably, emergency physicians will, at some time, be responsible for the management and care of a hazardous materials patient (see Chapter 6, Disaster Preparedness and Response).2

When managing a patient exposed to an industrial chemical, it is helpful to refer to the material safety data sheet. Here, specific physical and hazardous properties of a particular substance are described, including the risk for absorption after inhalation or dermal exposure, and the potential for systemic toxicity (Table 198-1). But although the material safety data sheet will also include “first aid” recommendations, it is strongly recommended to consult with a medical toxicologist or a regional poison control center to discuss optimal, case-specific hazards, treatments, and dispositions. [Some agents may result in delayed onset of symptoms that require at least 24 hours of monitoring (Table 198-2)]. Also, contacting the regional poison control center facilitates accurate data collection and analysis of toxicologic exposures in the community.

Table 198-1 Agents Absorbed through Intact Skin That May Result in Systemic Toxicity*
Table 198-2 Toxins with Delayed Onset of Symptoms or Requiring Prolonged Monitoring

This chapter discusses common industrial toxins that produce primarily respiratory and metabolic toxicity (Table 198-3). Toxic chemicals discussed elsewhere include nerve agents and vesicants (see Chapter 9, ...

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