Medical Management Guidelines for Acrolein
(C3H4O)
CAS# 107-02-8
UN# 1092
PDF Versionpdf icon[187 KB]
Synonyms include 2-propenal, 2-propen-1-one,
prop-2-en-1-al, acraldehyde, acrylaldehyde, acrylic aldehyde,
allyl aldehyde, ethylene aldehyde, aqualine.
- Persons exposed only to acrolein vapor do not pose secondary
contamination risks. Persons whose clothing or skin is contaminated
with liquid acrolein can secondarily contaminate others
by direct contact or off-gassing vapor.
- At room temperature, acrolein is a clear, colorless to
straw-colored liquid with a pungent, suffocating odor. It
is highly flammable and burns to produce toxic gases (peroxides
and oxides of carbon). It is volatile, producing toxic concentrations
at room temperature. Vapors may travel to a source of ignition
and flash back. The odor of acrolein may not provide adequate
warning of hazardous concentrations.
- Acrolein is toxic by all exposure routes. Exposure causes
inflammation and irritation of the skin, respiratory tract,
and mucous membranes. Delayed pulmonary edema may occur
after inhalation. Systemic effects may occur after exposure
by any route.
General Information
Description
Acrolein is a clear, colorless, or yellow
liquid with a pungent, suffocating odor. It is very flammable
and may polymerize violently. Acrolein should be stored in
a cool, dry, well-ventilated area in tightly sealed containers
separated from alkaline materials such as caustics, ammonia,
organic amines, or mineral acids, strong oxidizers, and oxygen.
Acrolein is soluble in water, alcohol, ether, and acetone.
Routes of Exposure
Inhalation
Inhaled acrolein is highly toxic. Acrolein
is irritating to the upper respiratory tract even at low concentrations.
Its odor threshold of 0.16 ppm is similar to the OSHA permissible
exposure limit (0.1 ppm); thus odor may provide an adequate
warning of potentially hazardous concentrations. Acrolein
vapor is heavier than air, but asphyxiation in enclosed, poorly
ventilated, or low-lying areas is unlikely due to its strong
odor.
Children exposed to the same levels of
acrolein vapor as adults may receive a larger dose because
they have greater lung surface area:body weight ratios and higher minute volumes: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 acrolein vapor found nearer to the ground.
Skin/Eye Contact
Direct contact with liquid acrolein causes rapid and severe eye and skin irritation or burns. Exposure to vapor produces inflammation of mucous membranes and it is a potent lacrimator.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin.
Ingestion
Acrolein produces chemical burns of the lips, mouth, throat, esophagus, and stomach. Nausea, vomiting, and diarrhea also occur.
Sources/Uses
Acrolein is produced by oxidation of
propylene.
Acrolein is principally used as a biocide to control plants, algae, molluscs, fungi, rodents, and microorganisms. Acrolein has also been used in the manufacture of other chemicals, as a warning agent in gases, as a test gas for gas masks, in military poison gases, in the manufacture of colloidal metals, in leather tanning, and as a fixative in histology.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 0.1 ppm as an 8-hr TWA concentration and 0.3 ppm as a 15-minute
TWA short-term exposure limit (STEL).
NIOSH IDLH (immediately dangerous to
life or health) = 2 ppm.
AIHA ERPG-2 (maximum airborne concentration below which it is believed that nearly all persons could be exposed for up to 1 hour without experiencing or developing irreversible or other serious health effects or symptoms that could impair their abilities to take protective action) = 0.5 ppm.
Physical Properties
Description : Clear, colorless to yellow liquid
Warning properties : Suffocating, pungent odor at 0.16 ppm
Molecular weight : 56.06 daltons
Boiling point (760 mm Hg): 126.5°F (52.5°C)
Freezing point : -126°F (-88.0°C)
Vapor pressure : 210 mm Hg at 68°F (20°C)
Gas density : 1.94 (air = 1)
Specific gravity : 0.84 (water = 1)
Water solubility : 208 g/L at 20°C
Flash point : -15°F (-26.1°C)
Flammable range : 2.8% to 31% (concentration in air)
Incompatibilities
Acrolein reacts with caustics, ammonia, organic amines, or mineral acids, strong oxidizers, and oxygen.
Health Effects
- Acrolein is severely irritating to skin, eyes, and mucous
membranes. Inhalation of acrolein may result in respiratory
distress and delayed pulmonary edema. Contact with the skin
or eyes produces irritation and lacrimation, and can result
in chemical burns.
- The mechanism by which acrolein produces toxic symptoms
is not known, but the compound is highly reactive. No information
was found as to whether the health effects of acrolein in
children are different than in adults. Exposure to acrolein
produces severe respiratory problems and individuals with
pre-existing breathing difficulties or skin disease may
be more susceptible to its effects.
Acute Exposure
The mechanism by which acrolein produces
toxic symptoms is not known, but the compound is highly reactive,
cross-links DNA, and inhibits the activities of some enzymes
(including cytochrome P450 and glutathione-S-transferase)
in vitro by reacting with sulfhydryl groups at the
active sites. It has also been shown to suppress pulmonary
antibacterial defenses, to release oxygen radicals, and to
react with proteins. Onset of irritation is immediate, but
pulmonary edema may be delayed and respiratory insufficiency
may persist for up to 18 months after exposure.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
Respiratory
Acrolein produces irritation of the respiratory
tract, increases airway resistance and tidal volume, and decreases
respiratory frequency. It is also ciliastatic. Exposure to
acrolein vapor concentrations as low as 10 ppm can lead to
pulmonary edema and death. Inhalation may also cause an asthmatic
reaction in sensitized individuals.
Acrolein is a weak sensitizer.
Children may be more vulnerable because
of higher minute ventilation per kg and failure to evacuate
an area promptly when exposed.
Dermal
Acrolein is a skin irritant. Contact
with the liquid may cause skin burns, erythema, and edema.
Because of their relatively larger surface
area: body weight ratio, children are more vulnerable to toxicants
affecting the skin.
Ocular/Ophthalmic
Acrolein liquid or vapor can cause eye
irritation and damage to the cornea.
Gastrointestinal
Acrolein causes burns of the lips, mouth,
throat, esophagus, and stomach. Nausea, vomiting, and diarrhea
have been reported. No data were located as to whether ingestion
leads to systemic toxicity in humans.
Cardiovascular
Acrolein inhalation may cause hypertension
and tachycardia.
CNS
Serious poisoning may cause CNS depression.
Immunologic
Acrolein may have the potential to be
immunotoxic.
The immune system in children continues
to develop after birth, and thus children may be more susceptible
to certain chemicals.
Potential Sequelae
Respiratory insufficiency may persist
for up to 18 months after exposure.
Chronic Exposure
Apart from rare cases of sensitization,
no adverse effects in humans chronically exposed to low concentrations
of acrolein have been reported.
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
has determined that acrolein may possibly be a human carcinogen.
The International Agency for Research on Cancer has determined
that acrolein is not classifiable as to its carcinogenicity
to humans.
Reproductive and Developmental Effects
No studies were located that address
reproductive or developmental effects of acrolein in humans.
Acrolein caused developmental effects when injected into rats,
but did not cause developmental effects when ingested by rabbits.
No information was found as to whether acrolein crosses the
placenta, but it has been measured in breast milk.
Acrolein is not 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.
Prehospital Management
- Victims exposed only to acrolein vapor do not pose contamination
risks to rescuers. Victims whose clothing or skin is contaminated
with liquid acrolein can secondarily contaminate response
personnel by direct contact or by off-gassing vapor.
- Acrolein is a direct irritant to mucous membranes, skin,
eyes, and the respiratory system. Acute inhalation exposure
may lead to respiratory distress and noncardiogenic pulmonary
edema.
- There is no antidote for acrolein. Treatment consists
of respiratory and cardiovascular support.
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
Acrolein is highly toxic via all routes
and is severely irritating to the eyes, mucous membranes,
respiratory tract, and skin. Acrolein is highly flammable,
can form explosive mixtures with air, and burns to produce
irritating, corrosive and/or toxic gases. Acrolein vapor may
travel to a source of ignition and flash back.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of acrolein.
Skin Protection: Chemical-protective
clothing is recommended because acrolein can cause skin irritation,
burns, and sensitization. Fully encapsulating, vapor protective
clothing should be worn to deal with spills or leaks with
no fire.
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
Patients exposed only to acrolein vapor
who have no skin or eye irritation may be transferred immediately
to the Support Zone. Other patients will 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. Quickly remove and double-bag contaminated
clothing and personal belongings.
Flush exposed skin and hair with copious
amounts of water. Wash with soap and rinse thoroughly with
water. Use caution to avoid hypothermia when decontaminating
victims, particularly children or the elderly. Use blankets
or warmers after decontamination as needed.
Flush exposed or irritated eyes with
tepid water for 15 minutes. Remove contact lenses if easily
removable without additional trauma to the eye. Continue eye
irrigation during other basic care and transport. If pain
or injury is evident, continue irrigation while transferring
the victim to the Support Zone.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
a dose of 1 g/kg (infant, child, and adult dose). A soda can
and a straw may be of assistance when offering charcoal to
a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child). If the victim is symptomatic,
delay decontamination until other emergency measures have
been instituted.
Consider appropriate management of chemically
contaminated children at the exposure site. 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 or have been exposed only
to vapor pose no serious risks of secondary contamination
to rescuers. In such cases, Support Zone personnel require
no specialized protective gear.
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, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
a dose of 1 g/kg (infant, child, and adult dose) if it has
not already been administered. A soda can and a straw may
be of assistance when offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child) if it has not been given previously.
If the victim is symptomatic, delay decontamination until
other emergency measures have been instituted.
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
that acrolein inhalation may cause hypertension and tachycardia,
in which case the use of bronchodilators that are known cardiac
sensitizing agents may pose enhanced risk. Administer corticosteroids
as indicated to patients who have persistent wheezing or hypersensitivity
pneumonitis.
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 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 acrolein has been ingested, prepare
the ambulance in case the victim vomits toxic material. 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.
Patients who are seriously symptomatic
(as in cases of chest tightness or wheezing), patients who
have histories or evidence of significant exposure, and all
patients who have ingested acrolein should be transported
to a medical facility for evaluation. Others may be discharged
at the scene after their names, addresses, and telephone numbers
are recorded. Those discharged should be advised to seek medical
care promptly if symptoms develop (see Patient Information
Sheet below).
Emergency Department Management
- Hospital personnel in an enclosed area can be secondarily
contaminated by direct contact or by off-gassing vapor from
soaked skin or clothing. Patients do not pose contamination
risks after contaminated clothing is removed and the skin
is washed.
- Acrolein is irritating to mucous membranes, skin, eyes,
and the respiratory tract. Acute inhalation exposure may
lead to respiratory distress and noncardiogenic pulmonary
edema.
- There is no antidote for acrolein. Treatment consists
of respiratory and cardiovascular support.
Decontamination Area
Unless previously decontaminated, all
patients suspected of contact with acrolein liquid and all
victims with skin or eye irritation require decontamination
as described below. Because acrolein reacts with the skin,
don butyl rubber gloves and an apron before treating patients.
Acrolein 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
that react with the skin. Also emergency room 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
that acrolein inhalation may cause hypertension and tachycardia,
in which case the use of bronchodilators that are known cardiac
sensitizing agents may pose enhanced risk. Administer corticosteroids
as indicated to patients who have persistent wheezing or hypersensitivity
pneumonitis.
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 ventricular arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag contaminated
clothing and all personal belongings.
Flush exposed skin and hair with water
for 2 to 3 minutes (preferably under a shower), then wash
thoroughly with mild soap. Rinse thoroughly with water. Use
caution to avoid hypothermia when decontaminating victims,
particularly children or the elderly. Use blankets or warmers
after decontamination as needed.
Flush exposed eyes with plain tepid water
for at least 15 minutes. Remove contact lenses if easily removable
without additional trauma to the eye. If pain or injury is
evident, continue irrigation while transporting the patient
to the Critical Care Area.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
a dose of 1 g/kg (infant, child, and adult dose) if it has
not already been administered. A soda can and a straw may
be of assistance when offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child) if it has not been given previously
(see Critical Care Area below for more information
on ingestion exposure).
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 under Decontamination
Zone. Establish intravenous access in seriously ill patients
if this has not been done previously. 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 symptoms. Treat patients
who have bronchospasm with an aerosolized bronchodilator such
as albuterol. Consider that acrolein inhalation may cause
hypertension and tachycardia, in which case the use of bronchodilators
that are known cardiac sensitizing agents may pose enhanced
risk. Administer corticosteroids as indicated to patients
who have persistent wheezing or hypersensitivity pneumonitis.
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.
Skin Exposure
If the skin was in contact with liquid
acrolein, chemical burns may occur; treat as thermal burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
affecting 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
Do not induce emesis. If the victim
is alert, asymptomatic, and has a gag reflex, administer a
slurry of activated charcoal at a dose of 1 g/kg (infant,
child, and adult dose) if it has not already been administered.
A soda can and a straw may be of assistance when offering
charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child) if it has not been given previously.
Consider endoscopy to evaluate the extent
of gastrointestinal-tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyrotomy. Gastric
lavage is useful in certain circumstances to remove caustic
material and prepare for endoscopic examination. Consider
gastric lavage with a small nasogastric (NG) tube if: (1) a
large dose has been ingested; (2) the patient's condition
is evaluated within 30 minutes; (3) the patient has oral lesions
or persistent esophageal discomfort; and (4) the lavage can
be administered within one hour of ingestion. Care must be
taken when placing the gastric tube because blind gastric-tube
placement may further injure the chemically damaged esophagus
or stomach.
Because children do not ingest large
amounts of corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless performed under endoscopic guidance.
Toxic vomitus or gastric washings should
be isolated, e.g., by attaching the lavage tube to isolated
wall suction or another closed container.
Antidotes and Other Treatments
There is no antidote for acrolein. Treatment
is supportive of respiratory and cardiovascular functions.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
Patients who have respiratory complaints may require pulse
oximetry (or ABG measurements), chest radiography, and peak-flow
spirometry.
Disposition and Follow-up
Consider hospitalizing patients who have
histories of significant inhalation exposure and are symptomatic
(e.g., chest tightness or wheezing) or who have ingested acrolein.
Delayed Effects
Pulmonary edema may be delayed for 24
hours after inhalation exposure and respiratory dysfunction
may remain for as long as 18 months after exposure.
Patient Release
Patients who remain asymptomatic for
24 hours after exposure may be discharged with instructions
to seek medical care promptly if symptoms develop (see the
Acrolein--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
emergency department (ED) visit to the patient's doctor.
If significant inhalation or skin contact
has occurred, monitor pulmonary function. In rare cases individuals
may be permanently sensitized and may need to be removed from
future work with acrolein; patients should consult an occupational
medicine or pulmonary specialist before returning to work
that entails exposure to acrolein.
Patients who have corneal injuries should
be reexamined within 24 hours.
Reporting
If a 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
acrolein.
Print this handout only.pdf icon[50.5 KB]
What is acrolein?
Acrolein is a colorless to pale-yellow
liquid with a strong, pungent odor. Acrolein is principally
used as a biocide to control plants, algae, molluscs, fungi,
rodents, and microorganisms. Acrolein has also been used in
the manufacture of other chemicals, as a warning agent in
gases, as a test gas for gas masks, in military poison gases,
in the manufacture of colloidal metals, in leather tanning,
and as a fixative in histology.
What immediate health effects can be caused by
exposure to acrolein?
Low levels of acrolein in the air can
irritate the eyes, nose, throat, and lungs and cause cough,
chest tightness, and shortness of breath. Higher levels can
cause a build-up of fluid in the lungs, which may cause death.
If liquid acrolein comes in contact with the skin or eyes,
it can cause severe burns. Generally, the more serious the
exposure, the more severe the symptoms.
Can acrolein poisoning be treated?
There is no antidote for acrolein, but
its effects can be treated and most exposed persons get well.
Seriously exposed persons may need to be hospitalized.
Are any future health effects likely to occur?
Respiratory dysfunction may persist for
over a year. In rare cases, after exposure to acrolein, certain
persons can be sensitized so that even small exposures to
acrolein or other irritants can trigger allergic reaction.
Therefore, it is important to tell your doctor that you have
been exposed to acrolein. The Department of Health and Human
Services has determined that acrolein may possibly be a human
carcinogen, based in part on limited evidence of cancer in
rats that were exposed to acrolein in the drinking water for
a lifetime.
What tests can be done if a person has been exposed
to acrolein?
Specific tests for the presence of acrolein
in blood are not available. If a severe exposure has occurred,
respiratory function tests and a chest x-ray may show whether
lung damage has occurred. In some cases, lung damage may not
be noticed immediately following exposure. Specialized tests
exist for reacted hemoglobin in blood and for modified DNA
in white blood cells.
Where can more information about acrolein be
found?
More information about acrolein 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.
Print instructions only.pdf icon[50.5 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing, wheezing, difficulty breathing, shortness of
breath, or chest pain
- increased pain or a discharge from your 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.