Friday, February 25, 2011

MEDICAL MATTERS ON CHEMICAL TANKERS-- CAPT AJIT VADAKAYIL

CHEMICAL ANTIDOTES


Every day, I find some poor soul seeking Chemical Antidote information on my blog site. 


Well, it is NOT right, to publish this on the web -- as self medication is NOT a good thing.


On the other hand, -- knowledge is power




             MEDICAL MATTERS

EmS is emergency schedules to MFAG-- appendix to IMDG code.
MFAG is medical first aid guide
CHRIS is chemical hazards response information system

Symptoms of chemical poisoning by inhalation/ ingestion:---
Headache
Vomiting
Drowsiness
Convulsions
Change in behavior
Pain
Rapid and weak pulse
Blue colour of skin
Difficulty in breathing
Severe allergy
Unconsciousness

Complications due to poisoning:---
Bronchitis
Pulmonary odema
Heart failure
Kidney/ liver failure

Asphyxia:
Due to lack of oxygen in the blood
Blockage of air by vomit
Chemical poisoning
Obstruction of airway due to severe allergy
Fluid in lungs
Poisoning of blood by CO
Gases which do not support life like Nitrogen

Master must not hesitate to seek radio medical assistance for chemical poisoning and injury cases. If proper treatment is given in good time recovery will be faster.

Never give Morphine to a person who has been gassed  especially by irritant gases..

For all poisoning you can give a glass of milk. Milk should NOT be given for degreasing solvents and Chlorinated Hydrocarbon poisoning.

Carbon Monoxide poisoning makes the lips bright red and the face pink.

Ammonia poisoning causes watering eyes and irritation of airway.

Pulmonary odema: You drown in your own body secretions. Fluid collects in lungs and you have difficulty in breathing or lying flat. Caused by inhalation of certain gases or by vomited matter going into lungs. It can be delayed by as much as 2 days.  This is the reason why the ships oxygen resuscitator is equipped with a Guedel airway which can vaccum out froth from the airway. If the patient is conscious he must be kept in a sitting up position and if unconscious kept in the three prone position. The medicine used is Furosemide. Every chemical man must be familiar .

For cargoes like Phenol --- Poly Ethylene Glycol is the antidote for skin ingestion.

For Cyanide poisoning break an ampoule of Amyl Nitrate 0.17 mg in a handkerchief and hold under nose. Repeat every 3 minutes , 5 times.

Pneumonia is inflammation of lobes of lung. Dry cough with expectorations of yellow, green or blood tinged. There will be severe pain on coughing. Treat using Ampicillin as an antibiotic. For allergic to Penicillin people give Cotri moxazole .

Anaphylaxis is allergy and swelling of tissue which can be fatal.

Carbon is activated by heating to 800 C which results in a honeycomb structure.

Toxic and noxious gases have distinctive odours except Carbon Monoxide.

Viruses are only half alive. They are parasites relying on a living host cell. It can reproduce only within living cells. Several viruses pass through membrane filters and are called filterable viruses. While squeegeing fish oils and animal tallow, wear virus filters.

Adrenaline causes increase of blood pressure and rate of heart beat.

Adsorbent has the ability to hold molecules , atoms and ions of other substances on its surface. Activated carbon, activated Alumina and Silica Gel are examples.

BOD/ biochemical oxygen demand is a standard means of estimating degree of contamination of water.

There are about 3500 known carcinogen compounds

Chloremphenicol is an antibiotic and antifungal agent.

Astringent reduces the size of skin pores.

Drinking sea water causes Chloride imbalance in the body.

Some gases can enter the body through intact skin and have been assigned with letter S

Some gases choke the sense of smell and are therefore not detected in dangerous concentrations

Skin cream does not reduce the amount of chemicals absorbed through the skin—but they protect the skin itself.

When taking ullage stand with the wind to your side.

Benzene causes blood cancer/ Leukaemia

Halogenated hydrocarbons cause  liver/ kidney/ nervous disease.

When oxygen is used for combustion in the cells of the body CO2 is formed. The CO2 is removed from the body via blood and the lungs. Oxygen is absorbed in the blood inside lungs and CO2 is expelled from blood.

Brain superior centres:  thought, judgement, controlled movements, senses

Brain subordinate centre: ( self regulating )—control auto functions like breathing, heart rate digestion, temperature regulation

Superior centres are affected first by toxic gases. Then subordinate centres get damaged.

CO2 is 50% heavier than air. Symptoms : prickling in nose, grey colour skin, rapid beat of heart, convulsions

CO: chemical asphyxiation by restricting O2 in blood. TLV/ 25ppm. It is flammable.
Normal filter type respirator is of no use as you cant smell CO.

H2S/ Gas is released by putrefaction and fermentation. Odour threshold <1ppm. Rapidly paralyses sense of smell. TLV/ 10 ppm. Heavier than air, eyes get sensitive to light.  Metallic taste in mouth, head ache , vomiting , diarhoea, paralysis , difficult breathing.

Proforma: Chemical/ TLV/ VP@20c
Cresol/ 5 ppm/ 0.1mb
Ethyl ether/ 100 ppm/ 586 mb

You have to be more careful with Ethyl Ether due to high VP.

Volatile liquid/ vapors enter through lungs into blood.

Vapors and liquids which affect the brain will usually paralyse cerebral cells and centres for a shorter or longer time. When the influence stops, the toxic molecules will be removed through the liver and the kidneys and the long term effect will most likely be a loss of brain cells.

Certain toxic substances like TDI and Nitriles enters blood and paralyses the nervous system and causes death.

If corrosive vapors are inhaled, the primary risk is damage to the mucous membranes in the respiratory tract. After inhaling small amounts of these vapors for longer periods, the alveolas will be filed with the substance . result is pulmonary odema, which means the alveolas will react against the corrosive vapor and produce fluid from the organism. The fluid will reduce the capability to absorb oxygen.  Causes pain in chest, coughing and rapid breath.  Give oxygen and Furosemide.

Skin ingestion without damaging the skin— Toluene, Phenol, Styrene, Methanol. ( use gas suit )

Many organic chemicals are corrosive, meaning they have the potential to damage the skin by burning or dissolution. It is very painful.

Ammonia burns ---wash by sea water.

When respiration has stopped—give artificial resuscitation with oxygen addition and heart compression.

Skin burn with pickling paste/ 2.5% Calcium Gluconate Gel.

Eye bath/ 3% Magnesium Sulphate

Never taste chemicals at sea.

For ships going to Malaria affected countries ( like West Coast Africa ) where Chloroquine is ineffective – it has been proved that Mefloquine is effective, against the resistant strain.

Aminophylline suppository, rectal, 500 mg
Use: To facilitate breathing in patients who have bronchial asthma, asthmatic bronchitis, pulmonary emphysema, and certain types of heart failure. Wheezing is usually an indication for use. The drug also has diuretic activity (increases urination). Give only on RADIO MEDICAL ADVICE.

Adult dosage: Insert one 500-mg suppository rectally. This dose may be repeated in 8-12 hours. The total dose should not exceed 1 g (2 suppositories) in 24 hours.

Caution: Store in a refrigerator at 2-8°C to prevent deterioration. Remove any wrapping before inserting the suppository. Rectal irritation may occur with continued use.

Ampicillin capsules, 250 mg
Use: For chest infections, urinary and gastrointestinal infections, and infections of the tonsils
and throat. Give only on RADIO MEDICAL ADVICE from a physician.

Adult dosage: Recommended for susceptible infections. The usual dosage is 1-2 250-mg capsules or tablets four times a day, up to the total dosage of 3.5 g (14×250-mg capsules) for one course of treatment.

The daily dose of ampicillin should be administered simultaneously with 2-4 500-mg tablets of probenecid (see page 326) to prolong the effective blood concentrations of ampicillin.

Caution: Ampicillin, chemically quite similar to penicillin, can cause the same types of allergic reaction, such as anaphylactic reaction and skin rash. Persons allergic to penicillin should be assumed to be allergic to ampicillin. Before administering, determine from the patient, if possible, whether he is allergic to either penicillin or ampicillin. Allergic (anaphylactic) reactions can be severe or even fatal. If the patient is allergic to the drug, RADIO MEDICAL ADVICE should be obtained for an alternative anti-infective treatment. If a reaction occurs, discontinue ampicillin, and give emergency treatment (see Allergic reactions, page 167).

Ampicillin may produce other side-effects such as nausea, vomiting, or diarrhoea.


Atropine sulfate injection, 0.5 mg/ml
Use: Injectable atropine sulfate is included for use as an antidote in the treatment of poisoning by insecticides containing organophosphate or carbamate chemicals as part of their formulation. Get RADIO MEDICAL ADVICE in the event of such poisoning.

Adult dosage: If it is determined that one of the above-mentioned poisons is involved, atropine sulfate should be administered at once to prevent coma, cyanosis, or convulsions. In organophosphate or carbamate poisoning, 2-3 mg should be given subcutaneously at once, followed by 1 mg every 15 minutes, until the skin is flushed and dry, or the pulse is mild and rapid. If cyanosis (bluish discoloration of skin) occurs, oxygen should also be administered.

Caution: The above doses, which are needed to counteract the poison, result in dry, flushed, or warm skin, dryness of the mouth, rapid pulse, and rapid breathing. These symptoms may lead to restlessness, hallucinations, and disorientation, followed by depression, medullary paralysis, and death. Do not administer this drug before obtaining RADIO MEDICAL ADVICE.


Calamine lotion, plain
Use: For relieving itching or irritated skin, heat rash, and hives. Shake the bottle well. Wet a pad of cotton with the lotion and pat it on the affected area.

Caution: Do not use on open or "weeping" sores,


Calcium gluconate, effervescent tablets, 1 g
Use: This medicament is intended to be used primarily in cases of poisoning by oxalic acid or
sodium fluoride. This sort of poisoning may cause a depletion of the calcium content of the blood, resulting in convulsions. Calcium gluconate acts by restoring needed calcium to the blood,

Adult dosage: Dissolve 5 tablets in 250 ml of water, to be drunk immediately.

INTERNATIONAL MARITIME ORGANIZATION. Medical first aid guide for use in accidents involving dangerous goods. London, IMO, 1985.


Charcoal, activated, powder
Use: In the initial treatment of most poisonings (because of its property to adsorb many poisons).

Adult dosage: 10 g (2 tablespoonfuls). Mix the powder with water prior to administration. Repeat if the patient vomits,

Note: Activated charcoal is a general antidote. It should not be used in place of the specific antidote for a poison when that antidote is available (see Chapter 2, page 53). It should not be used on unconscious patients, because of the danger of aspiration of the powder.

Chlorphenamine maleate tablets, 4 mg
Use: For treating allergic reactions, such as hay fever, urticaria, and anaphylactic shock (in addition to other measures).

Adult dosage: 1 tablet, one to three times daily,

Caution: Side-effects including drowsiness, dryness of mouth, blurred vision, nausea, and sweating, may occur in people taking this medicament.

The patient's ability to work may be impaired. Alcoholic drinks increase the likelihood of side-
effects.

Do not give to patients with a history of glaucoma, asthma, or peptic ulcer; consult the doctor
before giving it to pregnant women or to children.

Chlorphenamine maleate injection, 10 mg in 1 ml
Use: See previous item. May be given subcutaneously or intramuscularly.

Adult dosage: 1 to 2 injections a day.

Caution: As for chlorphenamine maleate tablets, above.

Diazepam injection, 5 mg/ml, 2 ml
Use: (1) For treatment of severe agitation, including acute alcohol withdrawal states and convulsions (epilepsy); (2) may be useful for shivering due to generalized hypothermia, see page 262.

Adult dosage: The usual dosage is 2-10 mg (intramuscularly, deep into the muscle), which may be repeated once in 1-4 hours, depending upon the response and the severity of the condition,

Caution: The injection should be given only on medical advice. Overdosage leads to fatigue, drowsiness, diminished reflexes, dizziness, mental confusion, and coma. It should not be given with sedative preparations or narcotics, as it may intensify sedation. Side-effects with normal dosages may include dryness of the mouth, subnormal body temperature, fever, slurred speech, or visual disturbances in a very few persons. The dosage should be adjusted or the medicament discontinued, if these symptoms occur.

The drug should be given with extreme caution to persons prone to drug abuse.

Warning: A controlled substance. Keep an exact record of its use. Store in a locked cabinet,

Diazepam tablets, 5 mg
Use: (1) For treatment of common anxiety and tension, and (2) for the management of agitation during alcohol withdrawal.

Adult dosage: Varies from 2 to 10 mg, 2-4 times a day, depending upon the condition being treated.

Caution: Overdosage leads to fatigue, drowsiness, light-headedness, diminished reflexes, dizziness, mental confusion, and coma. Patients exhibiting drowsiness should not be allowed to work complicated machinery or stand watch.

Other precautions as far diazepam injections, see previous item.

Warning: The same as for diazepam injections, see previous Item.

Dimercaprol injections, 50 mg/ml, 2-ml (= 100-mg) ampoules
Use: The drug is used as an antidote in poisoning. Indicated in the treatment of arsenic (pesticides), gold, and mercury poisonings; also in acute lead poisoning, in combination with calcium disodium edetate. Always obtain RADIO MEDICAL ADVICE in the event of such poisoning.

Recommended dosage (in adults): If general symptoms of poisoning occur, give dimercaprol,
200 mg intramuscularly every 6 hours for the first day, every 8 hours on the second day, and then twice a day for 3 days. Injections should be deep into the muscle; the site of injection should be changed at each administration.

Caution: Adverse reactions to this medicament include: headache, nausea, vomiting, abdominal pain; pain and sterile abscesses at injection sites; raised blood pressure and excessively rapid heart action (the blood pressure and pulse rate will return to normal within 2 hours).

Ephedrine sulfate capsules, 25 mg
Use: (1) To relieve difficult breathing in asthma; (2) to prevent asthmatic attacks in chronic cases (effects appear 30-60 minutes after administration); and (3) to relieve nasal congestion in hay fever and severe head colds. Obtain RADIO MEDICAL ADVICE before using this drug.

Adult dosage: One 25-mg capsule four times a day. If ephedrine is used for several days, phenobarbital may be indicated to overcome its stimulant effects (one 30-mg phenobarbital tablet up to three times a day).

Caution: Adverse effects include tremors, heart palpitation, mental anxiety, insomnia, and headache. The drug should not be given to patients with chronic heart disease, high blood pressure, glaucoma, diabetes, or hyperthyroidism. It may cause urinary retention in older men.

Epinephrine hydrochloride injection, 1:1000, 1 ml
Use: (1) For acute asthma attacks and for severe allergic reactions to penicillin and other drugs, and to insect bites; (2) for cardiac or circulatory failure.

Adult dosage: By subcutaneous or intramuscular injection, 0.3 ml of 1:1000 solution, every 2
hours as necessary. The usual dosage range is 0.1-0.5 ml in asthma, and up to 1 ml in other
conditions.

Caution: Epinephrine may cause anxiety, heart palpitation, and headache. Excessive doses can cause acute hypertension and irregular heartbeat. Except in life-threatening situations, it should not be administered to patients with hypertension, diabetes, hyperthyroidism, or heart disease.

Erythromycin tablets, 250 mg
Use: For a variety of infections of the upper and lower respiratory tract; infections of the mouth, gums, and teeth; infections of the nose, ears and sinuses. Give this antibiotic only when RADIO MEDICAL ADVICE has been received from a physician. It may be useful for patients allergic to penicillin, and for some infections resistant to penicillin.

Adult dosage: One 250-mg tablet, four times a day (for serious infections, dosage may be increased to two 250-mg tablets, four times a day) -to be continued for 48 hours or more after symptoms have subsided.

Caution: Occasionally, a skin rash may develop that will require discontinuation of the drug. If the drug is discontinued because of a sensitivity reaction, RADIO MEDICAL ADVICE on alternative therapy should be obtained. Sometimes abdominal discomfort, cramping, or nausea and vomiting may occur; these complaints usually diminish as therapy continues. The drug should not be given to people known to be sensitive to it.

Eye anaesthetic drops (0.5% solution of tetracaine hydrochloride)
Use: For local anaesthesia of the eye, before removing foreign bodies. Put 3 drops inside the
eyelids, repeat this three times at 2-minute intervals.

Caution: Careful use is advised in patients with known allergies. After receiving these drops, the eye should be protected by a pad.

Eye anti-infective drops (1% solution of chloramphenicol)
Use: For treating infectious eye diseases (blepharitis, conjunctivitis). Apply 3-4 drops to each eye, three to four times a day, in the manner described in Eye medication (page 118).

Eye ointment (1% tetracycline hydrochloride)
Use: (1) For superficial eye infections, trachoma, inflammation of the eyelids and tear sacs, and (2) for the prevention of eye infection when an injury renders the eye or an adjacent area vulnerable to infection.

If the eye infection does not improve in 24 hours, RADIO MEDICAL ADVICE should be obtained.

Adult dosage: Apply the ointment on the inside of the lower eyelid (see Fig. 113, page 120) every 3-4 hours.

Caution: Do not let the tip of the eye-ointment tube touch the eyelid (thus avoiding contamination of the medicament).

Persons known to be allergic to tetracycline should not be treated with this ointment.

The ointment should be used for a limited period of time only (about a week), if it is given without doctor's control.

Eyewash or eye-irrigating solution, isotonic, sterile
Use: For irrigating or flushing the eye to wash away foreign particles, mucous secretions, and
fluorescein dye used in diagnosis. Before use, warm the bottle with the solution to body temperature.

Directions: Point the tip of the applicator downwards towards the eye and gently squeeze the
plastic bottle to irrigate the eye. Use generously.

Caution: Keep the container tightly closed. Do not let the dispensing tip touch the eye or any
surface, because this may contaminate the solution.

Fluorescein sodium ophthalmic strip, sterile
Use: This is an ophthalmic diagnostic agent, used for the detection of lesions or small foreign
bodies embedded in the cornea of the eyeball. Damaged-abraded or ulcerated-corneal tissue absorbs the dye, and the lesion appears greenish or yellowish. Foreign bodies are surrounded by a green ring.

Dosage and administration: Anaesthetize the eye with one drop of 0.5% tetracaine hydrochloride eye-drops. Remove the fluorescein strip from the sterile wrapper without touching the dyed end. Moisten the dyed end with sterile eye-irrigating solution, Lift the upper eyelid and touch the dyed tip of the strip to the outside corner of the eye; allow the dye to flow across the eye. The patient should close the eyelid tightly after application, to distribute the stain.

Caution: Before using the strip, if the eye is dry, instil a drop of sterile eyewash solution.

Furosemide tablets, 40 mg

Use: Furosemide is a potent short-acting diuretic, which causes the production of urine by affecting the kidneys. It is indicated in the treatment of excess body fluid (oedema) associated with congestive heart failure, cirrhosis of the liver, or certain kidney diseases.

Dosage: The usual oral dosage for adults is 20-80 mg in a single dose in the morning, for 2-4 consecutive days each week, followed by a drug-free period. However, the dosage will vary, depending on the disease and the patient's response.

Caution: This drug should be used only after getting RADIO MEDICAL ADVICE. The doctor will advise on the dosage and on possible side-effects. If excessive doses are administered, there is a rapid loss of sodium, potassium, and calcium electrolytes, in addition to water. The drug is contraindicated in women of child-bearIns age.

Hydrocortisone sodium succinate for injection, 100 mg
Use: USE ON MEDICAL ADVICE ONLY: (1) for severe shock-large doses, combined with standard methods of combating shock, help restore blood pressure and circulation; (2) for acute allergic reactions-after epinephrine (or other substances that elevate blood pressure)-to combat severe asthma, drug reactions, and anaphylactic reactions (for example, to penicillin); and (3) for the control of life-threatening inflammation of the lungs after a patient has inhaled vomit (aspiration pneumonitis). Exceptionally, in a case of anaphylactic shock, when there is no time to obtain RADIO MEDICAL ADVICE, 100 mg of this drug may be given intramuscularly.

Adult dosage and administration: Dosage depends on the type and severity of the condition. The dose may be as low as 20 mg per day to suppress inflammation, or as high as 2.5 g or more in severe shock. Administer intramuscularly or intravenously, strictly following the doctor's instructions.

Caution: Not for patients with ulcerated corneas, acute psychoses, or a history of active or inactive tuberculosis, except in special life-threatening situations. Use with caution in patients with a history of stomach ulcers, in patients suffering from infections, and in the presence of diabetes, hypertension, glaucoma, convulsive disorders, and chronic renal diseases.

Hydrocortisone ointment, 1%
Use: For temporary relief of certain skin disorders, common rashes, inflamed skin, and disorders causing itching and discomfort. It may be used for temporary relief of itching, burning, and soreness from haemorrhoids (piles).

Adult dosage: Apply a thin film to the affected skin 2-4 times a day, Apply sparingly and with gentle rubbing. Clean the skin before each use.

Warning: Do not apply to the eyes. Do not use for extended periods of time without a physician's order. Discontinue use, if the condition gets worse. This ointment should not be administered to patients with chickenpox, or to people suffering from general infections.

Ichthyol and glycerine ointment
Use: For treatment of boils, fishermen's hand infections, salt-water boils, etc.

Dosage: Apply once a day to the affected area.

Morphine sulfate injection, 10 mg/ml, 1 ml
Use: For severe pain not relieved by other analgesics. Obtain RADIO MEDICAL ADVICE prior to use. Discontinue as soon as the pain can be relieved by other drugs that can be given orally and are less addictive.

Action of morphine:
■ relieves pain, calms the mind, reduces restlessness
■ depresses breathing and coughing
■ slows the heart rate
■ slows normal gut movements
■ may initially cause vomiting.

Adult dosage: For the relief of severe pain following injuries or burns, and severe pain of sudden origin in the abdomen or chest, give 10-15 mg intramuscularly. If the pain is unrelieved, or if it recurs soon after the first dose, a second dose of 10 mg intramuscularly may be given 1 hour or more later. Give further doses, if necessary, at intervals of at least 4 hours-not sooner. If the patient is to be transferred within 4 hours of receiving morphine, note the time and dosage on a tag securely tied to the front part of the patient's clothing.

Caution: An addiction-producing drug. Do not repeat the injection unless ordered to do so by a physician. Unless the radio medical doctor has instructed you to do so, NEVER GIVE MORPHINE:

(1)    when the respiratory rate has slowed to less than 12 breaths per minute;
(2)    when breathing is difficult (reduced) and the lips and skin are blue, or when the patient has a chest infection or asthma;
(3)    when mental dullness, unconsciousness, or coma are present, especially after head injury; and
(4)    for any uses other than those recommended in this guide, except on the order of a physician.

Warning: Morphine sulfate is a controlled substance. Keep an exact record of its use. Keep stock locked away.

Naloxone hydrochloride injection, 0.4 mg/ml, 1 ml
Use: For the emergency treatment of respiratory depression resulting from the administration of narcotics, such as morphine. Also indicated for the detection of suspected acute narcotic overdose.

Adult dosage: May be given by subcutaneous, intramuscular, or intravenous injection. The intravenous route of administration is recommended only for emergency situations. The usual dose is 0.4 mg, repeated every 2 or 3 minutes until a favourable response is achieved. If no improvement is noted after 2 or 3 doses, another cause of the depression should be suspected.

Obtain RADIO MEDICAL ADVICE on whether the use of naloxone is indicated.

Caution: The use of naloxone does not preclude that of other resuscitative measures when indicated, such as the maintenance of an adequate airway, artificial respiration, and heart compression. Naloxone is not effective in the treatment of respiratory depression caused by non-narcotic drugs, such as alcoholic beverages, and hypnotics such as phenobarbital.

Neomycin + bacitracin ointment (5 mg neomycin + 500 international units bacitracin zinc per gram)
Use: In treatment and prevention of infection, in second- and third-degree burns.

Adult dosage: The cream or ointment should be applied to cleansed burnt areas once or twice daily to a thickness of 1-2 mm. Continue as long as there is a possibility of infection, unless a significant adverse reaction occurs.

Caution: Local adverse reactions may occur, such as pain, burning, or itching. RADIO MEDICAL ADVICE should be sought to determine whether the drug should be discontinued.

Oral rehydration salts, in aluminium bag, sealed (contents of each bag to be dissolved in 1 litre of boiled cooled water)
Use: For the treatment of diarrhoea and other diseases causing dehydration.

Dosage: Give the solution to the patient to drink rapidly, for instance, 1 glass every 5-10 minutes, until the signs of dehydration disappear (see Diarrhoea page 188, and Cholera, page 128). Then give 1 glass after each bowel movement, to replace the continuing loss of water and salts.

Oxygen
Oxygen is a gas that constitutes about 20% of ordinary air; it is necessary for the maintenance of life.

Use: To make up for lack of oxygen in blood and tissues, the signs and symptoms or which are cyanosis (bluish colour to skin and nail-beds), dyspnoea (rapid, shallow breathing), rapid,
thready pulse, and restlessness. Oxygen may be indicated for respiratory diseases, cardiac diseases, poisoning from gases, massive haemorrhage, and shock.

Adult dosage: The usual adult dose is 6-8 litres per minute by mask; or 5-6 litres per minute by nasal catheter,

Caution: Only trained personnel should administer oxygen. The use of oxygen presents an explosion hazard. In the immediate area, do not allow any smoking, open flames, electrical devices, flammable liquids (such as alcohol and ether), or any device that may cause a spark or is combustible. Compressed oxygen is marketed in metal cylinders; these must be handled carefully to prevent their falling or bumping into each other.

Petrolatum (white petroleum jelly)
Use: As a bland and neutral protective dressing. Apply to minor burns, abrasions, or dry skin.                                                                

Potassium permanganate (crystals), 100 g
Use: Diluted in water (1 g of crystals to 0.5-1 litre of water). This substance is used for the disinfection of the skin and mucous membranes and for the treatment of some skin diseases.

Caution: The substance (or any highly concentrated dilution of it) is very toxic if ingested.

Salbutamol, aerosol
Use: In bronchial asthma, as inhaled spray. The medicament dilates the bronchi and brings quick relief (within several minutes) in an asthmatic attack.

Adult dosage: Usually 0.1-0.5 ml (2 puffs) of solution of salbutamol, given as a spray. Closely follow manufacturer's instructions on how to use the spray.

Sodium chloride injection, 0.9%, 500 ml
Use: Intravenously (1) to replace water chloride, and sodium lost in extensive vomiting or diarrhoea, (2) in dehydration due to excessive sweating, and (3) in mild haemorrhage. Obtain RADIO MEDICAL ADVICE before administering (see page 117).

Adult dosage: Depends on patient's condition, Generally, 1500-3000 ml may be given over 24 hours. Do not give intravenous solutions at a faster rate than 500 ml per hour, except on RADIO MEDICAL ADVICE.

Caution: As with any injection, sterile procedures should be observed. Do not administer any intravenous solution unless it is clear and free of particles. Watch the solution carefully while it is being administered. In order to keep air from entering the patient's vein, do not allow the bottle to drain completely of fluid.

Zinc oxide paste (Lassar's plain zinc paste)
Use: A nontoxic, protective, water-insoluble, mildly astringent, and antiseptic paste employed
in a large variety of diseases and irritations of the skin. Zinc oxide paste differs from zinc oxide ointment in that it is somewhat more protective.

Dosage: Apply as needed in a thin layer to skin areas to be treated or protected from sunlight or weather.

                         Medicines recommended to be carried on board ships for treatment of people exposed to toxic substances

Name
Recommended
standard unit
Format
Quantity
Aluminium Hydroxide, with magnesium
hydroxide or magnesium trisilicate
1 g
tablet
100
Aminophylline
360 mg
suppository
60
Ampicillin
500 mg
capsule
100
Ampicillin
500 mg
ampoule
100
Amyl nitrite
0.17 mg in 0.2 ml
ampoule
96
Ascorbic acid (Vitamin C)
1 g
tablet
120
Ascorbic acid (Vitamin C)
500 mg in 5 ml
ampoule
20
Atropine suIfate
1 mg in 1 ml
ampoule
200
Calcium gluconate 2%
25 g
tube
6
Calcium gluconate effervescent
1 g
tablet
10
Charcoal, activated
5 g
sachet or power
10
Chlorphenamine
10 mg in 1 ml
ampoule
20
Chlorpromazine
25 mg in 1 ml
ampoule
80
Diazepam
10 mg in 2 ml
ampoule
60
Dimercaprol
100 mg in 2 ml
ampoule
160
Ethyl alcohol 10% solution
500 ml
bottle
4
Fluorescein sodium 1% or 2%

eye test strip
100
Furosemide
20 mg in 2 ml
ampoule
40
Furosemide
40 mg
tablet
80
Glucose
500 g
powder
1
Macrogol 300
1 litre
bottle
2
Methylene blue 1%
10 ml
ampoule
40
Metoclopramide hydrochloride
10 mg in 2 ml
ampoule
60
Morphine suIfate
15 mg in 1 ml
ampoule
30
Naloxone hydrochloride
0.4 mg in 1 ml
ampoule
30
Paracetamol
500 mg
tablet
120
Phytomenadione (Vitamin K1)
10 mg in 1 ml
ampoule
4
Salbutamol aerosol inhaler unit
0.1 mg per dose
200 dose container
4
Sulfamethoxazole + trimethoprim
400 + 80 mg
tablet
50
Tetracycline hydrochloride, 1%, eye ointment
4 g
tube
10
 This drug is also recommended for inclusion in the basic ship’s medicine chest (Table 10).
However, recommended quantities may be different.


FEW USEFUL MEDICINES

Atropine Sulphate / pesticide poisoning. antispasm , to increase pulse rate
Vitamin K/ anticoagulanant . for rodenticide poisoning.
Calcium Gluconate/ Fluorides / Oxalates poisoning.
Nalaxone HCL/ side effects of Morphine, respiratory depression due to narcotics
Diazepam/ convulsions
Metronidazol suppository/ vomiting
Aminophylline tablets/ bronchodilator for asthma relief.
Ephedrine Hydrochloride tablets/ asthma , breathlessness
Promethazine Hydrochloride/ allergic asthma, antihistamine
Calamine lotion/ skin rashes, eczema
Adrenaline injection/ broncospasm, severe allergy
Chlorpheneramine Maleate/ allergy, hayfever
Chloremphenicol eye drops/ conjunctivitis, antibiotic, antifungal
Tannic acid jelly/ burn ointment
Codein linctus/ chronic bronchitis
Cotrimoxazole tablets/ respiratory tract infection, sinusitis
Ibuprofen tablets/ anti inflammatory tablets
Ampicillin/ antibiotic for chest infections
Aluminium acetate ear drops/ outer ear infection
Prednisolone Sodium Phosphate eye drops/ chemical burns
Few broncodilators/ Terbutaline, Asthalin, Salbutamol
Betamethasone/ allergic bronchitis
Erythromycin Ethyl Succinate EES/ middle ear infection
Deriphyline/ allergic bronchitis
Dimercaprol injection/ antidote to poison



Threshold Limit Value – Time Weighted Average -The Threshold Limit Value Time Weighted average (TLV-TWA) is usually expressed in units of parts per million (ppm) - The TLV is defined as the concentration of the substance in air that can be breathed for five consecutive eight-hour workdays (40-hour work week) by most people without adverse effect . As some people become ill after exposure to concentrations lower than the TLV, this value cannot be used to define exactly what is a "safe" or "dangerous" concentration.
No entry appears when the chemical is a mixture; it is possible to calculate the TLV for a mixture only when the TLV for each component of the mixture is known and the composition of the mixture by weight is also known.

Threshold Limit Value - Short-Term Exposure Limits - The parts of vapor (gas per million parts of contaminated air by volume at 25oC (77oF) and one atmosphere pressure is given. The limits are given in milligrams per cubic meter for chemicals that can form a fine mist or dust. The values given are the maximum permissible average exposures for the time periods specified.

Threshold Limit Value – Ceiling Value – The parts of vapor (gas per million parts of contaminated air by volume at 25oC (77oF) and one atmosphere pressure is given. The limits are given in milligrams per cubic meter for chemicals that can form a fine mist or dust. The values given are for a concentration that is not to be exceeded at any time.
OSHA puts TLV of Benzene at 1 ppm

Toxicity by Ingestion - The Grade and corresponding LD50 value are those defined by the National Academy of Sciences, Committee on Hazardous Materials, "Evaluation of the Hazard of Bulk Water Transportation of Industrial Chemicals, A Tentative Guide," Washington, D.C., 1972. Data were also collected from other sources and converted to the appropriate Grade before entry in this manual. The term LD50 signifies that about 50% of the animals given the specified dose by mouth will die. Thus, for a Grade 4 chemical (below 50 mg/kg) the toxic dose for 50% of animals weighing 70 kg (150 lb) is 70 X 50 = 3500 mg = 3.5 g, or less than 1 teaspoonful; it might be as little as a few drops. For a Grade 1 chemical (5 to 15g/k g), the LD50 would be between a pint and a quart for a 150-lb man. All LD50 values have been obtained using small laboratory animals such as rodents, cats, and dogs. The substantial risks taken in using these values for estimating human toxicity are the same as those taken when new drugs are administered to humans for the first time.

Toxicity by Inhalation – Similar to the Toxicity by Ingestion entry, except that the route of exposure is inhalation instead of ingestion. Units and definition of units are the same.

Chronic Toxicity - Where there is evidence that the chemical can cause cancer, mutagenic effects, teratogenic effects, or a delayed injury to vital organs such as the liver or kidney, a qualitative description of the effect is given.

Odor Threshold - This is the lowest concentration in air that most humans can detect by smell. The value cannot be relied on to prevent over-exposure, because human sensitivity to odors varies over wide limits, some chemicals cannot be smelled at toxic concentrations, odors can be masked by other odors, and some compounds rapidly deaden the sense of smell

IDLH Value - The Immediately Dangerous to Life and Health Value - This concentration represents a maximum level from which one could escape within 30 minutes without any escape-impairing symptoms or any irreversible health effects. The concentrations are reported in either parts per million (ppm) or milligrams per cubic meter (mg/m3).

Antidote/drug
Indication
Amyl Nitrite (for inhalation)
Cyanides, Nitriles
Atropine (for injection)
Organophosphates, Carbamates
Budesonide (for inhalation)
Irritant gases
Betamethasone (for injection)
Irritant gases
Calcium Gluconate (topical)
Hydrofluoric acid
Calcium salts (for iniection)
Hydrofluoric acid
Cobalt edetate
Cyanides ( Nitriles)
Copper solution
Phosphorus white (yellow)
Dimercaprol
Arsenic, mercury
Dimercaptopropane sulphonate (DMPS)
(for injection) (tabiets)
Arsenic, mercury
Dimercaptosuccinic acid (DMSA)
(for injection) (tabiets)
Arsenic, mercury
Hydroxocobalamin (for injection)
Cyanides/nitriles
4-Dimethylaminophenoi (4-DMAP)
Cyanides
Methylthionine (methylene blue) (for injection)
Nitrites, nitrobenzene (and other methaemogiobin-forming agents)
Obidoxime (for injection)
Organophosphates
Oxygen1
Carbon monoxide, cyanides, hydrogen sulphide, irritant gases, nitriles
Polyethylene glycol 400 (topical)
Phenol
Potassium permanganate +
Sodium Bicarbonate (topical)
Phosphorus, white (yellow)
Pralidoxime (for iniection)
Organophosphates
Salbutamoi (for inhalation)
lrritant gases
Sodium Nitrite
Cyanides, Nitriles
Sodium thiosulphate (for iniection)
Cyanides, Nitriles
Terbutaline Sulphate (for inhalation)
lrritant gases
Tetracaine Hydrochioride (eye drops)
For eye irrigation
Toluidine blue (for iniection)
Nitrites, Dinitrobenzene (and other Methaemogiobin-forming
Xanthine derivatives

lrritant gases


-------CAPT AJIT VADAKAYIL






3 comments:

  1. I’m glad to find so many useful and informative data on your website. NAC EyeDrops

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  2. I appreciate your information on the Bronchitis. I wrote about this, too, recently. More specifically about the causes and cure to Bronchitis.

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  3. While there are many harmful chemical ingredients in our beauty products, the two I find myself discussing most often are petrolatum and sodium laurel sulfate (SLS), simply because they are the most ubiquitous.

    Petrolatum (also known as petroleum jelly and many other names), a petroleum by-product, is used as a cosmetic base and can be found in almost all skin care, cosmetics, and hair products. All petrochemicals are extremely detrimental to our health, and because petrolatum is used as a base, it makes up a huge portion of any given product. Unlike harmful synthetic preservatives and additives, which usually account for a very low percentage of the formulation (but must also be avoided), petrolatum and other petrochemicals are present in large quantities

    ReplyDelete