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Piratox sheet 2 : "Hydrogen arsenide or arsine" 26/01/2012

3 pages
Les fiches Piratox et Piratome sont destinées aux professionnels de santé susceptibles d’intervenir en cas d’attentats, d’actes de malveillance ou d’accidents industriels mettant en œuvre des matières nucléaires, radiologiques ou chimiques (de guerre ou industrielles). Elles décrivent les recommandations et les réponses thérapeutiques d’urgence à mettre en œuvre et s’adressent en premier lieu aux SMUR et SAMU, aux services d’incendie et de secours, mais également aux professionnels de santé des services d’urgence, de réanimation et des centres antipoison.Les fiches Piratox et Piratome ont pour vocation de compléter les travaux sur la thématique NRC et les consignes des circulaires 700 et 800 du Secrétariat général de la défense et de la sécurité nationale, qui précisent l’organisation des secours ainsi que les modalités de prise en charge des victimes sur le terrain.Les recommandations thérapeutiques sont volontairement limitées à la prise en charge des victimes lors des 24 premières heures tant sur le lieu de l’évènement que dans les établissements de santé.Prise en charge des intoxications aux agents chimiques (entrée par catégorie d'agent chimique)Prise en charge des contaminations internes à divers radionucléides (entrée par antidote, la fiche n°1 oriente le choix de l'antidote)Biotox / Piratox/Piratome - Fiches Piratox/Piratome de prise en charge thérapeutique
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Edition of October 2011
! Key points not to forget   The 1stemergency measuresare: -from the hazard area: respiratory protection of rescuers is essential; of victims  extraction -(first and foremost undressing) of victims, possibly completed emergency decontamination by thorough decontamination depending on the context1.  Treatment is symptomatic and linked to the existence and extent of intravascular haemolysis.  As a general rule, the shorter the symptom onset time, the more serious the intoxication and the more severe the symptoms.  Asymptomatic patients shall be kept under observation for at least 6h due to the risk of haemolysis.  Symptomatic patients shall be kept under observation for at least 48h to monitor the onset of acute effects. Schedule increased observation of patients presenting with significant symptoms.  mode of hydrogen arsenide intoxication is mainly by inhalation. The  arsenide can lead to delayed arsenic intoxication. Hydrogen  additional information concerning the risk, assistance with patient treatment and follow-up, we For recommend contacting the poison control centers, military health service, or referring healthcare establishments.   1. Pharmaco-toxicological class of the toxic compound  Hydrogen arsenide is a powerful haemolytic poison that acts directly on red blood cells, causing massive intravascular haemolysis. It should be noted that inorganic arsenic is carcinogenic in humans.   2. Physicochemical properties of arsine relevant to treatment 
 ARSINE (Hydrogen arsenide, AsH3) Comments Characteristics and CAS number: 7784-42-1  Physical state of the product aG stao °C; PM *;C  11 6 = -* BPe ur °63- =  yranidrtarepmet Vapour phase dispersion VapourGas heavier than air density: d= 2.7 Water-solubility Water-soluble up to 200 mL for 1L of water. Transfer of contamination Not expected *BP: boiling point = tematpuerer of transition frlioqmu id to vapour state. **MP: melting point = temperatuarne soitfi otrn from solid to liquid state.   
1Decontamination procedures (cf. 02 ha 80ebmet7 rctdun io indronthsee)t .erfcrichcn no.ular/SGD 700/EPP/NSPN vo Sfo
AfssapsDEMEB / SURBUM / Toxicology Dept / Clinical Toxicology Unit -/ Tel. Secr.:+33 1 55 87 34 75. 143/147, bd Anatole France - F-93285 Saint-Denis cedex - Tel. +33 1 55 87 30 00 -etnas.spassfa.wwwr .f 
Edition of October 2011 
3. Main intoxication characteristics  Arsine is present only in gaseous form (BP = -63°C). Arsine enters the body mainly via the respiratory route. Skin penetration has never been reported and remains negligible relative to the respiratory route. Highly liposoluble, arsine rapidly crosses alveolar-capillary and red blood cell membranes, causing intravascular haemolysis.
 Toxic doses
 Main symptoms
 Onset times after exposure
  AEGL:Acute Exposure Guideline Levels, limit AsH3 in air, in parts per concentrations million (ppm), effects are likely to develop over a given exposure time.beyond which health    AEGL3 Time of exposure to AEGL1discomfort death or
AsH3 impairment risk of death 30 minutesednd.2 0pp1 0.m eruston cer emmo pm  Epx6p3o  During the acute phase, the symptoms and onset time vary according to intoxication intensity.   In the event of mild intoxications and/or prolonged exposure to low concentrations, the following is observed: - asthenia, headaches, nausea, muscle weakness, aches, - appearance of "port wine" colored urine, - garlic-smelling breath.   pronounced acute intoxications, the following is observed:In the event of - headaches, dizziness and shivering, digestive signs (nausea and vomiting), abdominal, lumbar and muscle pains, - massive intravascular haemolysis with its consequences= disseminated intravascular coagulation, hyperkalaemia, metabolic acidosis, state of shock, acute pulmonary oedema, acute anuric kidney failure.    In hyperacute forms: - loss of consciousness/syncope/coma,  - the situation rapidly progresses to death by acute circulatory failure and multiple organ failure. Complications: - death by cardiovascular collapse associated with the massive haemolysis and by direct myocardial toxicity,  oligo anuric kidney failure associated with the haemolysis and direct tube impairment; - - anaemia. -Following the acute phase, signs related to inorganic arsenic intoxication may appear.   . 2 - 24 h: headaches, malaise, weakness, state of shock, dizziness, dyspnoea, thirst, abdominal pains, nausea, vomiting, pallor, jaundice, cyanosis. . 4 - 6 h: burgundy "haematuria" urine. . 24 - 48 h: jaundice. . In severe intoxications, the symptoms may appear as early as 30 to 60 minutes, but may be delayed up to 36 hours.  
Afssaps/ DEMEB / SURBUM / Toxicology Dept / Clinical Toxicology Unit -Tel. Secr.:+33 1 55 87 34 75. 143/147, bd Anatole France - F-93285 Saint-Denis cedex - Tel. +33 1 55 87 30 00 -aps.santew.wfwr. afss 
Edition of October 2011 
4. Antidotes (specific treatments):  No antidote for hydrogen arsenide-induced haemolysis has been approved to date.  The chelating agent dimercaprol (BAL®) has repeatedly been reported to be ineffective in preventing haemolysis, even when administered early. Subsequent monitoring of these patients should be organised due to the possible late complications associated with the presence of mineral arsenic. Indeed, there is a risk of secondary inorganic arsenic intoxication that could justify the administration of a chelating agent. In this case, initiate chelator treatment (DMSA® or BAL® have been suggested in the event of vomiting, see Piratome sheet no. 1, table A: treatment of arsenic) as rapidly as possible to prevent development of severe renal impairment.   5. Symptomatic treatments  Treatment is symptomatic and is dictated by the existence and severity of intravascular haemolysis:
-  - -
Symptomatic treatment of acidosis and state of shock. Transfusions of packed red blood cells. Exchange transfusion.  
-Dialysis; renal impairment prevents the use of chelating agents.    Monitoring of acute effects: -patients: 6h observation for risk of haemolysis.  Asymptomatic - Symptomatic patients: observation for 48h.   Special monitoring: - Acute kidney failure. - arsenic intoxication (e.g.: neurological disorders). Delayed  
Afssaps/ DEMEB / SURBUM / Toxicology Dept / Clinical Toxicology Unit -Tel. Secr.:+33 1 55 87 34 75. 143/147, bd Anatole France - F-93285 Saint-Denis cedex - Tel. +33 1 55 87 30 00 -as.s.etn rfwwafw.apss 
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