Medical Management Guidelines for Ethylene Dibromide
(C2H4Br2)
PDF Versionpdf icon[286 KB]
CAS#: 106-93-4
UN#: 1605
Synonyms include 1,2-dibromoethane, glycoldibromide,
and bromofume.
- Persons whose clothing or skin is contaminated with liquid
ethylene dibromide (above 50ºF) can secondarily contaminate
others by direct contact or through offgassing vapor.
- A liquid at room temperature, ethylene dibromide readily
penetrates skin, cloth, and other protective materials such
as rubber and leather. It is nonflammable.
- Ethylene dibromide is a colorless, heavy liquid with a
sweet chloroform-like odor. It's odor is not detectable
at a low enough concentration to be considered a warning
of excessive exposure.
- Absorption can occur by the inhalation, oral, and dermal
routes. It is toxic by these three routes of exposure. Toxicity
is thought to be due to metabolic products of ethylene dibromide.
General Information
Description
Ethylene dibromide is a nonflammable
colorless liquid with a sweet chloroform-like odor at room
temperature above 50ºF (10ºC). It is slightly soluble
in water and soluble in most organic solvents. It is heavier
than water. When heated to decomposition, it may release gases
and vapors such as hydrogen bromide, bromine, and carbon monoxide.
Ethylene dibromide should be stored in a dry place at ambient
temperature.
Routes of Exposure
Inhalation
Inhalation is an important route of exposure.
Ethylene dibromide's odor is not detectable at a low enough
concentration to be considered a good warning of excessive
exposure. Ethylene dibromide vapors are heavier than air and
can accumulate in poorly ventilated or low-lying areas.
Fatalities have occurred among workers
cleaning a tank containing residues of ethylene dibromide.
The dermal route also contributed to the exposure.
Children exposed to the same levels of
ethylene dibromide as adults may receive larger doses because
they have greater lung surface area:body weight ratios and
higher minute volume:weight ratios. In addition, they may
be exposed to higher levels than adults in the same location
because of their short stature and the higher levels of ethylene
dibromide vapors found nearer to the ground.
Skin/Eye Contact
Ethylene dibromide can penetrate ordinary
rubber gloves and leather. Prolonged skin contact with the
liquid may cause erythema, blistering, and skin ulcers. Skin
absorption may contribute to systemic toxicity.
Because of their relatively larger surface
area:weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Ingestion
Acute toxic effects, including fatal
systemic poisoning, can result from ingestion. Rapid effects
following ingestion can include abdominal pain, diarrhea,
nausea, vomiting, and drowsiness.
Sources/Uses
Ethylene dibromide is produced by liquid-phase
bromination of ethylene at 35-85ºC. This is followed
by neutralization to free acid and purification by distillation.
Ethylene dibromide was used extensively as a scavenger for
lead in gasoline and as a pesticide and an ingredient of soil,
vegetable, fruit, and grain fumigant formulations. However,
these uses have almost disappeared in the United States. It
is used to some extent as a chemical intermediate, gauge fluid,
and as a nonflammable solvent for resins, gums, and waxes.
Standards and Guidelines
OSHA 8-hour TWA = 20 ppm; acceptable
ceiling concentration = 30 ppm
NIOSH REL-TWA = 0.045 ppm; 15-min ceiling
limit = 0.13 ppm
NIOSH IDLH (immediately dangerous to
life or health) = 100 ppm
Physical Properties
Description: Colorless; liquid
at room temperature and solid below 50ºF (10ºC)
Warning properties: Inadequate
for exposure to vapors
Molecular weight: 187.9 daltons
Boiling point (760 mm Hg): 268ºF
(131ºC)
Freezing point: 50ºF (10ºC)
Vapor pressure: 11 mm Hg at 77ºF
(25ºC)
Liquid specific gravity: 2.172
at 77ºF (25ºC)
Gas density: 6.48 (air = 1)
Water solubility: Water soluble
(0.43% at 86ºF) (30ºC)
Flammability: Nonflammable
Incompatibilities
Incompatible with strong oxidizers, magnesium,
alkali metals, and liquid ammonia.
Health Effects
- Ethylene dibromide is a liquid at ambient temperatures
that can cause skin, eye, mucous membrane, and respiratory
tract irritation. It may also cause damage to the lungs,
liver, and kidneys. These effects can result from all routes
of exposure.
- The systemic effects of ethylene dibromide are in part
due to metabolic conversion to the cell toxicant 2-bromoacetaldehyde.
- Persons with pre-existing skin disorders or eye problems,
or impaired liver, kidney, or respiratory tract function
may be more susceptible to the effects of ethylene dibromide.
Acute Exposure
Ethylene dibromide alkylates macromolecules
causing cellular disruption and reduced glutathione levels.
Cellular disruption in tissues and organs, such as liver and
kidneys, results in progressive dysfunction. Manifestation
of some of the effects of acute high exposure may be delayed
a few days.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
Respiratory
Early symptoms of acute exposure include
irritation of the nose and throat. Exposures of moderate to
severe intensity produce respiratory manifestations ranging
from cough, chest pain, and dyspnea to bronchitis, pneumonitis,
pulmonary edema, and hemorrhage. Pulmonary edema occurred
3 days after oral poisoning in one fatal human case.
Children may be more vulnerable because
of higher minute ventilation per kg and failure to evacuate
an area promptly when exposed. Hydrocarbon pneumonitis may
be a problem in children.
CNS
Ethylene dibromide is a mild central
nervous system depressant. Drowsiness has been reported following
ingestion and inhalation. Inhalation of vapors in a confined
oxygen-deficient space has caused rapid loss of consciousness,
coma, and death.
Dermal
Liquid ethylene dibromide is a skin irritant.
Brief skin contact or contact with contaminated clothing causes
erythema and discomfort. Splashing of the liquid on the skin
causes a sensation of cooling because the liquid evaporates
quickly. Prolonged skin contact may cause blistering and skin
ulcers (may be delayed 24-48 hours). Ethylene dibromide can
be absorbed through the skin to produce systemic effects.
Exposure to certain chemicals can lead
to Reactive Airway Dysfunction Syndrome (RADS), a chemically-
or irritant-induced type of asthma.
Because of their larger relatively surface
area:body weight ratio, children are more vulnerable to toxins
absorbed through the skin.
Ocular/Ophthalmic
Conjunctivitis has been reported after
exposure to ethylene dibromide. Eye contact with the compound
may cause temporary loss of vision because of destruction
of tissues in the eye.
Hepatic
Ethylene dibromide poisoning often affects
the liver. Significant liver damage has resulted from inhalation
and ingestion of ethylene dibromide. Necrosis of the liver
was a chief finding in a fatal case of acute oral poisoning.
In two fatal cases of inhalation/dermal exposure, serum aspartate
aminotransferase and lactic dehydrogenase were elevated before
death.
Renal
The kidney is often affected in ethylene
dibromide poisoning. Severe renal lesions were reported in
fatal cases of acute oral poisoning and also inhalation poisoning.
Lesions included necrosis of the tubular epithelium, cytoplasmic
vacuolization of the proximal convoluted tubules, and tubular
protein casts.
Gastrointestinal
Abdominal pain, nausea, vomiting, and
diarrhea have been reported after ethylene dibromide ingestion.
Metabolic
Metabolic acidosis can occur after high
exposure to ethylene dibromide.
Potential Sequelae
Patients who develop severe acute neurologic
injury but survive may have both central and peripheral neurologic
effects that persist indefinitely.
Carcinogenicity
The Department of Health and Human Services (DHHS), the
International Agency for Research on Cancer (IARC), and the
Environmental Protection Agency (EPA) have not had
sufficient evidence to classify elemental mercury as a
carcinogen or a noncarcinogen.
Chronic Exposure
No reliable reports exist of adverse
health effects in humans exposed chronically to ethylene dibromide.
Chronic exposure may be more serious
for children because of their potential for a longer latency
period.
Carcinogenicity
The Department of Health and Human Services
(DHHS) has determined that ethylene dibromide can reasonably
be anticipated to be a human carcinogen, based on ethylene
dibromide-induced tumors in multiple sites and by various
routes of exposure in animals. Results from epidemiological
studies have been inconclusive.
Reproductive and Developmental Effects
There is inconclusive but suggestive
evidence that ethylene dibromide may reduce fertility in men.
Antispermatogenic effects have been demonstrated in various
animal species. Ethylene dibromide is included in Reproductive
and Developmental Toxicants, a 1991 report published by
the U.S. General Accounting Office (GAO) that lists 30 chemicals
of concern because of widely acknowledged reproductive and
developmental consequences.
Special consideration regarding the exposure
of pregnant women is warranted, since ethylene dibromide has
been shown to be a genotoxin; thus, medical counseling is
recommended for pregnant women.
Prehospital Management
- Victims exposed only to ethylene dibromide gas do not
pose substantial risks of secondary contamination to personnel
outside the Hot Zone; however, some ethylene dibromide may
permeate clothing. Victims whose clothing or skin is contaminated
with liquid ethylene dibromide (i.e., ambient temperature
higher than 50ºF) can secondarily contaminate response
personnel by direct contact or through off-gassing vapor.
- Ethylene dibromide is a mucous membrane, skin, and eye
irritant. It may also cause respiratory distress and pulmonary
noncardiogenic pulmonary edema, liver and kidney toxicity,
drowsiness, coma, and death. Dermal absorption may contribute
to systemic toxicity.
- There is no antidote for ethylene dibromide. Treatment
consists of support of respiratory and cardiovascular functions.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Ethylene dibromide is a highly toxic
systemic poison that is readily absorbed following inhalation
and dermal exposure.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) with a full facepiece
is recommended in response situations that involve exposure
to potentially unsafe levels of methyl bromide vapor.
Skin Protection: Chemical-protective
clothing (including boots and gloves) is recommended because
ethylene dibromide vapor or liquid can be absorbed through
the skin and may contribute to systemic toxicity. Contact
with liquid ethylene dibromide can cause skin irritation and
blisters. Ethylene dibromide can penetrate ordinary rubber
gloves and leather.
ABC Reminders
Quickly establish a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of anxiety
in victims with chemically-induced acute disorders, especially
children who may suffer separation anxiety if separated from
a parent or other adult.
Decontamination Zone
Remove clothing, including footwear,
from all victims because ethylene dibromide persists in cloth,
leather, and rubber. After clothing has been removed, patients
exposed only to the gas who have no skin or eye irritation
may be transferred immediately to the Support Zone. All others
require decontamination as described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly establish a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Remove all contaminated clothing
including footwear. Ethylene dibromide can persist in cloth,
leather, and rubber, and these materials may contribute to
severe chemical burns after prolonged skin contact. Double-bag
contaminated clothing and personal belongings. Leave these
items in the Hot Zone.
Flush exposed skin and hair with water
for at least 15 minutes, then wash twice with mild soap. Rinse
thoroughly with water. Use caution to avoid hypothermia when
decontaminating patients, particularly children or the elderly.
Use blankets or warmers after decontamination as needed.
Irrigate exposed or irritated eyes with
plain water or saline for 15 to 20 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye. If pain or injury is evident, continue irrigation while
transferring the victim to the Support Zone.
If ingestion of liquid ethylene dibromide
occurs, do not induce emesis. If the victim is alert
and able to swallow, administer a slurry of activated charcoal
at a dose of 1 g/kg (infant, child, and adult dose). A soda
can and straw may be of assistance when offering charcoal
to a child.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination pose no serious risks of
secondary contamination. Support Zone personnel require no
specialized protective gear in such cases.
ABC Reminders
Quickly establish a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible. Administer supplemental oxygen
as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion of liquid ethylene
dibromide, do not induce emesis. If the victim is alert
and able to swallow, administer a slurry of activated charcoal
at a dose of 1 g/kg (infant, child, and adult dose). A soda
can and straw may be of assistance when offering charcoal
to a child.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyrotomy if equipped and trained to
do so.
Treat patients who have bronchospasm
with an aerosolized bronchodilator such as albuterol.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution, repeat every 20 minutes as needed,
cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
If evidence of shock or hypotension is
observed, begin fluid administration. For adults with systolic
pressure less than 80 mm Hg, bolus perfusion of 1,000 mL/hour
intravenous saline or lactated Ringer's solution may be appropriate.
Higher adult systolic pressures may necessitate lower perfusion
rates. For children with compromised perfusion administer
a 20 mL/kg bolus of normal saline over 10 to 20 minutes, then
infuse at 2 to 3 mL/kg/hour.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If the patient has ingested ethylene
dibromide, prepare the ambulance in case the patient vomits
toxic material or has diarrhea. Have ready several towels
and open plastic bags to quickly clean up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims. Because systemic symptoms may
be delayed for several hours after exposure, all exposed patients
should be transported to a medical facility for evaluation.
Symptomatic patients should receive priority in transport.
Emergency Department Management
- Hospital personnel away from the scene are not at significant
risk of secondary contamination from patients exposed to
vapors of ethylene dibromide or to liquid ethylene dibromide
(ambient temperatures greater than 50ºF); however,
some ethylene dibromide may have permeated clothing.
- Ethylene dibromide is a mucous membrane irritant and exposures
to high concentrations can cause eye, skin, and respiratory
tract irritation, as well as pulmonary edema. Dermal absorption
can contribute to systemic toxicity.
- High concentrations can also cause drowsiness, coma, and
death.
- There is no antidote for ethylene dibromide. Treatment
consists of support of respiratory and cardiovascular functions.
Decontamination Area
Unless previously decontaminated, all
patients suspected of contact with liquid ethylene dibromide
and all victims with skin or eye irritation require decontamination
as described below. Because ethylene dibromide is absorbed
through the skin, don butyl rubber gloves and apron before
treating patients. Ethylene dibromide readily penetrates most
rubbers and barrier fabrics or creams, but butyl rubber provides
good skin protection. All other patients may be transferred
immediately to the Critical Care Area.
Be aware that use of protective equipment
by the provider may cause anxiety, particularly in children,
resulting in decreased compliance with further management
efforts.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin. Also, emergency department personnel
should examine children's mouths because of the frequency
of hand-to-mouth activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, surgically create an airway.
Treat patients who have bronchospasm
with an aerosolized bronchodilator such as albuterol.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution, repeat every 20 minutes as needed,
cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag all clothing,
including footwear, because ethylene dibromide penetrates
many materials and can remain trapped in them. Leather absorbs
ethylene dibromide; items such as leather shoes, gloved, and
belts may require disposal by incineration.
Flush exposed skin and hair with water
for at least 15 minutes, then wash twice with mild
soap. Rinse thoroughly with water. Use caution to avoid hypothermia
when decontaminating patients, particularly children or the
elderly. Use blankets or warmers after decontamination as
needed.
Irrigate exposed or irritated eyes with
tap water or saline for 15 to 20 minutes. Remove contact lenses
if easily removable without additional trauma to the eye.
If pain or injury is evident, continue irrigation while transferring
the victim to the Critical Care Area. An ophthalmic anesthetic,
such as 0.5% tetracaine, may be necessary to alleviate blepharospasm,
and lid retractors may be required to allow adequate irrigation
under the eyelids.
If ingestion occurs, do not induce
emesis. If the victim is alert and able to swallow, and
if not already done, administer a slurry of activated charcoal
at a dose of 1 g/kg (infant, child, and adult dose). A soda
can and straw may be of assistance when offering charcoal
to a child.
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area, above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Establish
intravenous access in seriously ill patients. Continuously
monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory complaints. Treat patients
who have bronchospasm with an aerosolized bronchodilator such
as albuterol.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution, repeat every 20 minutes as needed,
cautioning for myocardial variability.
Observe these patients for 24 hours using
repeated chest examinations and other appropriate tests. Follow-up
as clinically indicated.
Skin Exposure
If the skin was in contact with concentrated
ethylene dibromide vapor or liquid, chemical burns may result;
treat as thermal burns. Burns may be delayed in onset.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Eye Exposure
Continue irrigation for at least 15 minutes.
Test visual acuity. Examine the eyes for corneal damage and
treat appropriately. Immediately consult an ophthalmologist
for patients who have corneal injuries.
Ingestion Exposure
If ingestion of liquid ethylene dibromide
occurs, do not induce emesis. If the victim is alert
and able to swallow, and if not already done, administer a
slurry of activated charcoal at a dose of 1 g/kg (infant,
child, and adult dose). A soda can and straw may be of assistance
when offering charcoal to a child.
Antidotes and Other Treatments
There is no proven antidote for ethylene
dibromide poisoning. Dimercaprol (BAL) or acetylcysteine (Mucomyst)
have been suggested as antidotes based on the postulated mechanism
of ethylene dibromide's toxicity. However, no adequate studies
have tested the efficacy of these therapies, and they are
not recommended for routine use.
Laboratory Tests
Serum bromide levels can be used to document
that exposure did occur. However, bromide levels do not accurately
predict the clinical course. Routine laboratory studies include
CBC, glucose, and electrolyte determinations. Additional studies
for patients exposed to ethylene dibromide include liver-function
tests and renal-function tests. In cases of inhalation exposure,
chest radiography and arterial blood gas measurements may
be helpful.
Disposition and Follow-up
Decisions to admit or discharge a patient
should be based on exposure history, physical examination,
and test results. The probable delay in onset of serious effects
from ethylene dibromide exposure should be considered.
Delayed Effects
Because the onset of pulmonary edema
may be delayed for up to several days, patients who have severe
exposure should be monitored with serial examinations before
absence of toxic effects can be assured. If pulmonary edema
is suspected, admit patients to an intensive care unit. Neurological
symptoms also may not develop for several days or weeks.
Patient Release
Patients who have no evidence of neuropsychiatric
or pulmonary effects 24 hours after exposure may be discharged
with instructions to return to the emergency department (ED)
if symptoms develop or recur (see the Ethylene Dibromide--Patient
Information Sheet below).
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Patients exposed to ethylene dibromide
should be monitored for late neuropsychiatric sequelae.
Patients who have corneal injuries should
be reexamined within 24 hours.
Reporting
Ethylene dibromide is a pesticide. If
a pesticide- or work-related incident has occurred, you may
be legally required to file a report; contact your state or
local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendix III for a list of agencies that may be
of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
ethylene dibromide.
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What is ethylene dibromide?
Ethylene dibromide is a colorless liquid
at ambient temperature, with a sweetish odor. Ethylene dibromide
has been used as a scavenger for lead in gasoline and as a
pesticide and an ingredient of soil and grain fumigant formulations.
These uses have virtually disappeared in the United States.
Minor uses include use as a chemical intermediate and as a
nonflammable solvent for resins, gums, and waxes.
What immediate health effects can be caused by exposure to ethylene dibromide?
Ingestion of the ethylene dibromide or
inhalation of vapors can cause injury to the brain, lungs,
and throat. High doses can also injure the kidneys and liver.
Contact with the skin and eyes can lead to irritation and
burns and can also contribute to systemic toxicity. Ethylene
dibromide may cause cardiac arrhythmias and sensitization.
Generally, the more serious the exposure, the more severe
the symptoms.
Can ethylene dibromide poisoning be treated?
There is no antidote for ethylene dibromide
poisoning, but its effects can be treated and most persons
recover. Persons who have experienced serious symptoms may
need to be hospitalized and may need follow-up examinations
or treatment later on.
Are any future health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a serious exposure that causes lung
or nervous system-related problems, permanent brain or lung
damage can result. The Department of Health and Humans Services
has determined that ethylene dibromide can reasonably be anticipated
to be a carcinogen.
What tests can be done if a person has been exposed to ethylene dibromide?
Specific tests for the presence of bromide
in blood may provide some useful information to the doctor.
If a severe exposure has occurred, blood and urine analyses
and other tests may show whether the lungs, brain, liver,
or kidneys have been damaged. Testing is not needed in every
case.
Where can more information about ethylene dibromide be found?
More information about ethylene dibromide
can be obtained from your regional poison control center;
your state, county, or local health department; the Agency
for Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in locating these telephone
numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
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[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing or wheezing
- difficulty in breathing, shortness of breath, or chest
pain
- difficulty in walking
- confusion, dizziness, or fainting
- increased pain or a discharge from exposed eyes
- increased redness or pain or a pus-like discharge in the
area of a skin burn
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.