Case Study: Chlorine Gas Toxicity
Youāre dispatched to a 16yom complaining of shortness of breath and and a sore throat. It is 15:15pm, and the patient has been at work as an assistant swim instructor. When you arrive, the staff advise that the patient suddenly began crying, coughing, complaining of a sore throat, nausea and dizziness about 20 minutes prior to calling 000.Ā
On arrival at the local pool, you're taken around the back of the site where the patient is standing beside shed. He is anxious and distressed, pacing and coughing.Ā
Consider:Ā
1. Primary SurveyĀ
D- Nil obvious, chemicals inside of shed.Ā
R- When you approach, the patient looks up at you and states "I can't breathe". (A)VPU
C- Regular, strong radial pulse.Ā
A- Patient able to speak and swallow, patent.Ā
B- Spontaneous and adequate.Ā
2. Secondary SurveyĀ
VSS:Ā
PR- 115, regular
BP- 128/64
SPO2: 92% on room airĀ
BGL- 6.2mmol/LĀ
Temp- 37.2cĀ
GCS-15
ECG4- sinus tachycardia at 115bpmĀ
Physical Exam
Head: Patient has tears streaming down his cheeks, red cheeks. Pt reports his vision is blurry due to the tears. Nil foreign body present in eyes. Ā
Neck: NADĀ
Chest: NAD
Back: NADĀ
Abdo: NAD
Extremities: NADĀ
SAMPLE historyĀ
S- lacrimation, shortness of breath, dizziness, Ā 4/10 throat pain described as burning, eye pain described as itchy, coughing, flushed skin
A- latex, pollen
M-Nasonex sprayĀ
P- tonsillectomy 6 months ago, nil episodes similar to todayĀ
L- Last ate at 13:30
E- patient was pouring chemicals into the pool pump when he suddenly noticed his throat felt irritated. He then felt dizzy and his eyes began producing tears. Staff state the patient accidentally used undiluted chlorine instead of diluted chlorine.Ā
3. Other assessments you want to perform?Ā
Respiratory assessment:Ā
Conscious state- alert
Appearance- moderately anxious
Pulse- as described above
Effort- accessory muscle use presentĀ
Rate- 34
Rhythm- regular
Sounds- bilateral basal inspiratory and expiratory wheeze Ā
Speech- phrasesĀ
Skin- Flushed, dry, warmĀ
History: What time did the patient enter the shed/pour the chemicals? How long was he inside? What time was symptom onset? Did he suffer any ingestion or direct skin contact?Ā
4. Provisional Diagnosis Chlorine gas toxicityĀ
5. Treatment PathwayĀ
1. Contact OpCen for firefighter/CBRIE assistance to manage risk of further exposure to othersĀ
2. Position patient sitting upright and provide reassurance
3. Nebulise Salbutamol to manage bronchospasmĀ
4. If SPO2 doesn't improve and respiratory distress remains after wheeze has resolved, provide supplemental O2.Ā
5. Irrigate eyes using water (drinkable water is acceptable) or normal saline.Ā
Conclusion:
The patient responds well to 5mg of nebulised salbutamol, resolving his wheeze. His RR reduces to 24. His SPO2 improves to 94% on room air. With supplemental oxygen via nasal cannula at 2lpm his SPO2 improves to 97%. His ocular irritation continues but it relieved with ongoing irrigation and then keeping his eyes closed.Ā
On arrival at hospital, the patient has a second episode of bronchospasm, which increased RR and wheeze. The hospital staff manage him with nebuilsed sodium bicarbonate, which resolves his symptoms.















