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Victims Management Due To Ammonia Exposure

According to Agency for Toxic Substances and Disease Registry (2014) victims
management due to ammonia divide to two part first is pre-hospital management and
second is hospital management:
Pre-Hospital:
1. The entire rescuer should be well trained in chemical disaster due to ammonia
management. They have to wear proper equipment such as respiratory
protection and skin protector that keep whole body from ammonia including
gloves, boots, aprons, full body suit, goggles and face shields. The following
materials have been proved good excellent resistance butyl rubber and Teflon
(Centers for Disease Control and Prevention,2013).
2. When rescuer arrive in contaminated area they should check patient airway
and make sure patient has adequate respiration and pulse and if cervical
trauma is suspected keep cervical with cervical collar or other devices that
maintain cervical immobilization.
3. If the victims can walk lead them to move out from contaminated area to
decontamination zone. If victims unable to walk may be removed on
backboards or gumeys, if these not available carry or drag the victims
carefully to decontamination area.
4. In decontamination area victims and rescuer must be decontaminated. Remove
all contaminated clothing and flush skin and hair with water for at least 5
minutes if possible using soap is recommended. Irrigate eyes with plain water
or normal saline for at least 15 minutes. If there are ingestion case don’t
induce with emesis drug instead give the victims water or milk. After
decontamination is complete move the victims immediately to the safe/support
zone
5. Transport the victims to the hospital
Hospital:
1. After victims were decontaminated and they have arrived in hospital, the
rescuer has to checks on victim’s airway, breathing and circulation. Watch for
sign of laryngeal edema and airway compromise. If the victim has
bronchospasm give his/her aerosolized bronchodilators or if the victim
experiences stridor give her/his epinephrine aerosol.
2. Administer supplemental oxygen by mask to patient who have respiratory
symptoms. If ammonia gas or solution was in contact with the skin, chemical
burn may result, treat as usual thermal burn.
3. For eyes that were contaminated with ammonia should continue irrigation at
last 15 minute until conjunctiva fluid has returned to normal. Examine the
corneal damage and treat properly. Consult to ophthalmologist if its needed.
4. For ingestion of ammonia case give water to the patient to dilute stomach
contents. Consider endoscopy to evaluate any gastrointestinal injury.
5. Delayed effect may occur in 18 to 24 hour including pulmonary injury.
Residual bronchoconstriction, bronchiectasis and small airway disease may
occur and chronic obstructive pulmonary disease can develop. If the
pulmonary defect getting worst the patient should treat in intensive care units.
6. All ammonia exposure patient must be given full attention until the signs and
symptoms of ammonia exposure are disappear. If the signs and symptoms
recur or develop the patient should get medical treatment properly.

References
Agency for Toxic Substances and Disease Registry.2014. Medical Management
Guidelines for Ammonia (NH3) [online]. Accessed from:
http://www.atsdr.cdc.gov/mmg/mmg.asp?id=7&tid=2 [Accessed on : September
25, 2014].
Centers for Disease Control and Prevention. 2013. The Emergency Response Safety
and Health Database [online]. Accessed from
http://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_29750013.html
[Accessed on : September 25,2014]