Acute exposure

Inhalation

The patient should be removed from exposure and all contaminated clothing removed. The respiratory function should be assessed. Further treatment is symptomatic and supportive. See below for management of systemic effects.

Dermal

Contaminated clothing should be removed and the skin thoroughly irrigated with water or saline. Further treatment is symptomatic and supportive. See below for management of systemic effects.

The eyes should be thoroughly irrigated with water or saline for 15 minutes and then stained with fluorescein. Referral to an ophthalmologist is recommended if there is any uptake of fluorescein.

Ingestion

1,1,1-TCE is radiopaque (Dally et al., 1987) and an X-ray may confirm ingestion. Gastric lavage may be considered if ingestion was recent, however, because of the risk of aspiration a cuffed endotracheal tube must be used to protect the airway. Activated charcoal is unlikely to be of benefit. If there has been any vomiting, coughing, or wheezing then the patient will need to be assessed to see if aspiration has occurred. Treatment is supportive. See below for management of systemic effects.

Systemic effects

Treatment is primarily symptomatic, with support of the cardiovascular and respiratory systems. Use of epinephrine (adrenaline) or related sympathomimetic stimulants is contraindicated due to the risk of inducing ventricular fibrillation.

The level of consciousness, ECG and respiratory rate function should all be monitored, along with liver and kidney function in severe cases. A chest X-ray is indicated in patients with respiratory symptoms and in cases of suspected aspiration.

The efficacy of enhanced elimination techniques (e.g., haemodialysis, haemoperfusion, etc.) has not been established, but on theoretical grounds they are unlikely to be effective.

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