Clinical Severity of Chlorine Gas Inhalation

Description

Inhalation of chlorine gas results in injury to the respiratory tract and can be deadly.

Mechanism of exposure: industrial, accidental, chemical warfare

Mechanisms of injury: chlorine mixed with water can form hydrochloric acid and hydrochlorous acid. Hydrochlorous acid can release nascent oxygen (O-) which results in free radicals.

Examination: vital signs, respiratory exam, chest X-ray and pulse oximetry

Clinical Symptoms	Exam	Severity
none	normal	none
coughing, minimal respiratory symptoms, no increase respiratory effort	normal pulse oximetry	mild
hypoxia, increased respiratory effort	abnormal pulse oximetry, normal chest X-ray	moderate
hypoxia, respiratory distress, ARDS	abnormal pulse oximetry, abnormal chest X-ray	severe

Severity	Observation Period	Therapy
none	none (can be discharged after assessment)	none
mild	up to 6 hours	inhaled beta-agonists
moderate	admit for observation for >= 12 hours	inhaled beta-agonists, inhaled steroids, oxygen supplement, inhaled ipratropium
severe	admit to ICU	consider intubation, consider mechanical ventilation, inhaled beta-agonists, inhaled or intravenous steroids, ipratropium

Prolonged exposure can result in edema of the upper airway with potential for airway obstruction. Intubation may be necessary to preserve the airway.

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Clinical Severity of Chlorine Gas Inhalation

Description

Specialty