Pediatric emergency medicine trisk 3116 3116
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those compounds with the potential for irreversible systemic toxicity ( Table
102.15 ), including halogenated hydrocarbons (e.g., trichloroethane, carbon
tetrachloride) and aromatic hydrocarbons (e.g., toluene, xylene, benzene). In
addition, some petroleum distillates contain dangerous additives, such as heavy
metals or insecticides.
Patients who have aspirated may exhibit immediate choking, coughing, and
gagging as the product is swallowed and then vomited after ingestion. Aspiration
of the product may also occur at the time of the initial swallowing. ED
management of these patients is outlined in Figure 102.10 . If the patient has any
cough or respiratory symptoms upon arrival to the ED, a chest radiograph should
be obtained immediately. Because there is a gradual evolution of abnormal
radiographs, an initially negative chest radiograph should be repeated at 4 to 6
hours after ingestion. All patients with abnormal chest radiographs or persistent
respiratory symptoms after 4 to 6 hours of ED observation warrant further
medical observation. Patients who are asymptomatic with normal chest
radiographs after 6 hours of observation may be discharged. Because pneumonitis
occasionally appears 12 to 24 hours after exposure, detailed instructions should
be provided for warning signs of respiratory dysfunction.
