Hospital Management Acute exposure

Inhalation

The victim 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.

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

Chloroform is radiopaque and an X-ray may confirm ingestion (Dally et al., 1987). 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 determine if aspiration has occurred. Treatment is supportive. See below for management of systemic effects.

Systemic effects

All patients initially require at least 24 hours observation with ECG monitoring. Blood concentrations of chloroform may be determined. Patients should be kept at complete bedrest, the use of stimulants, including epinephrine (adrenaline) and norepinephrine (noradrenaline), is best avoided because of the risk of sensitisation. In symptomatic patients hepatic and renal functions should be monitored for at least three days post exposure. Chest X-rays will be necessary to monitor the development of any respiratory complications.

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