Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Slide 45
Chemical Agents of Opportunity for Terrorism:
TICs & TIMs
Management
Sulfuryl Fluoride: Treatment
• Removal from source of exposure
• Ventilation
• Oxygen
• Monitor for hypocalcemia
– ECG (prolonged QTc)
– Serum or ionized Ca2+
• Administer calcium as needed
Module Four – Cyanide & Fumigants
45
As with all fumigants and gases the first step is to remove the patient from the exposure
source. Treatment should include ventilation and oxygen and the patient should be
monitored for hypocalcemia (usually identified on the ECG as a prolonged QT interval or
by obtaining a Serum or ionized Ca 2+ measurement).
Intravenous calcium is the treatment for this complication.
There is no specific antidote for sulfuryl fluoride itself.
The fluoride ion may be released from the compound in the body. This fluoride can bind
blood calcium and cause hypocalcemia, which results in neurologic and cardiac
abnormalities, which can be fatal if not treated. If patients develop fluoride-induced
hypocalcemia, the treatment is large doses of intravenous calcium chloride or calcium
gluconate.
Depending on the background of the participants, many will not be familiar with
electrocardiograms (ECG) monitoring or the specific intervals, such as the period of
cardiac electrical repolarization, as represented by the QT interval. A simple notation
that this interval is prolonged by many factors, including a very low blood calcium, is
sufficient.
December 2008 Version 2.0 Page 232