From: Alan Hall <ahalltoxic**At_Symbol_Here**MSN.COM>
Subject: Re: [DCHAS-L] First aid for Chemical exposures
Date: April 18, 2012 1:49:19 PM EDT
Reply-To: DCHAS-L <DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU>
Message-ID: <CAHGb5M2MizCvpatw1_9iaRqtVtkJxY4RHZpGuJv2CPdSmi9z8Q**At_Symbol_Here**>

You asked for it, you got it.
As a hyped-up world-class cyanide guy, here's my 2 cents worth.
IF you are handling cyanide in large quantaties (let's not even get into ingestions which are usually suicidal or homicidal) and there might be a possibility of very large quantity dermal exposures (say to liquid hydrogen cyanide in a hot humid environment or being buried in calcium cyanide) or more  likely to airborne hydrogen cyanide, then the advice of our old colleague Wurzburg would be to have appropriately trained first respoders equipped with an oxygen-powered breathing device (with mask) and to have amyl nitrite inhalers available to place inside the lip of the face mask.  worked well in one small series of industrial exposures.  This assumes you can still find a supplier of the amyl nitrite inhalars which may be difficult in todays regulatory environment.
IF you are handling only very dilute solutions of calcium, potassium, or sodium cyanide (say 1-2% solutions such are used in such applications as hospital autoanalyzers), then such precautions are unnecessary as there are no published cases of significant poisoning from such sources (you will see hyperventilation etc. in the ED when an exposure happens because  "everyone knows" cyanide  is a "bad actor", but an hour or so of careful monitoring and observation will sort the wheat from the chaff --and it will likely all be chaff).  Don't forget that hyperventilation syndrome (although perhaps an early sign of cyanide poisoning) is  much more common than cyanide poisoning and having the patient breath into a brown paper bag (or an unhooked oxygen mask) will allow them to reestablish normal plasma CO2 concentrations and shut off the involuntary hyperventilation response.
So no, for say a high school or college chemistry lab, I don't think stocking amyl nitrite would be necessary.  Might be different for a cyanide or cyanogen (nitrile) production or heavy industrial use facility.
Alan H. Hall, M.D.
Medical Toxicologist


Date: Wed, 18 Apr 2012 12:13:31 -0500
From: drrayng**At_Symbol_Here**GMAIL.COM
Subject: Re: [DCHAS-L] First aid for Chemical exposures

On the subject of first aid, what are your thoughts on having a cyanide poisoning kit on hand (amyl nitrite)?

On Wed, Apr 18, 2012 at 7:45 AM, Harry Elston < helston**At_Symbol_Here**> wrote:
So are any number of us on this list,  George.
However. I do not believe that one would need specific training for FIRST AID beyond what you find in open source literature.    Anything beyond rinse and EMS (and perhaps Ca gluconate for HF)  gets dangerously close to TREATMENT, which is beyond the scope of most.
Regarding calcium gluconate on HF,  I believe that one will find that as a first aid measure in the Honeywell HF reference booklet.
It is recognized that there are other washes available (e.g.  Diphoterine, Hexafluorine)  that are gaining traction, especially outside the US.  Alan Hall can speak more cogently about that than I can..    The peer-reviewed case studies using these solutions is mounting in a positive direction.
A couple of take home messages for first aid:
1.    Water and lots of it.
2.    Don't be a chemist on someone else's skin or eyes.  Or your own for that matter.
3.    Leave TREATMENT to the pros.  Think standard of care here.
Get your EHS group to run some exposure drills and honestly critique the outcome if you want some fun! You "can" hire it out,  but everyone still needs to be involved for it to be meaningful.

sent from my Samsung Captivate
On Apr 18, 2012 7:15 AM, "george wahl" < ghw917**At_Symbol_Here**> wrote:
Jim Kaufman would give you excellent training!

George Wahl

On Apr 17, 2012, at 9:21 AM, Humphrey, Karalyn J. wrote:

My department chair wants to have a training that specifically addresses first aid for chemical exposures.  Does anyone know of someone who might be certified/qualified to come and lead such a training?
Dr. Karalyn (Karen) Humphrey
Laboratory Coordinator, Department Safety Officer & Part-Time Lecturer
Baylor University Department of Chemistry & Biochemistry
Office: BSB E.111
Phone:  254-710-2002
"Vast worlds lie within the hollows of each atom, multifarious as the motes in a sunbeam."  ~Yoga Vasishtha

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