Neutralizing a caustic chemical
The article, "Hydrofluoric Acid Skin Exposure," (Action Stat, June, 2012)* was an admirably direct description of the potential severity of exposure to this chemical and the therapy that should be applied. However, we'd like to comment on the possible use of hexafluorine, an amphoteric, hypertonic solution that's shown promise as a decontaminating and neutralizing treatment in this type of case.1-4 The chemical decontamination unit at our hospital's ED has used this solution to treat ocular and cutaneous exposure to corrosive products for 3 years. The utility of this treatment is largely dependent on early application (although it doesn't always prevent systemic adverse reactions to hydrofluoric acid, such as hypocalcemia and hypomagnesemia).5
Some in vitro studies continue to show that running water has greater decontaminating efficacy than hexafluorine, but keeping hexafluorine available for immediate use in a workplace where there's risk of hydrofluoric acid exposure has been recommended.6,7
REFERENCES
1. Burgher F, Mathieu L, Lati E, et al. Part 2. Comparison of emergency washing solutions in 70% hydrofluoric acid-burned human skin in an established ex vivo explants model. Cutan Ocul Toxicol. 2011;30(2):108-115. [Context Link]
2. Spoler F, Frentz M, Forst M, Kurz H, Schrage NF. Analysis of hydrofluoric acid penetration and decontamination of the eye by means of time-resolved optical coherence tomography. Burns. 2008;34(4):549-555.
3. Soderberg K, Kuusinen P, Mathieu L, Hall AH. An improved method for emergent decontamination of ocular and dermal hydrofluoric acid splashes. Vet Hum Toxicol. 2004;46(4):216-218.
4. Yoshimura CA, Mathieu L, Hall AH, Monteiro MG, de Almeida DM. Seventy per cent hydrofluoric acid burns: delayed decontamination with hexafluorine(R) and treatment with calcium gluconate. J Burn Care Res. 2011;32(4):e149-e154. [Context Link]
5. Kaushik S, Bird S. Topical chemical burns. UpToDate. 2013. http://www.uptodate.com. [Context Link]
6. Hojer J, Personne M, Hulten P, Ludwigs U. Topical treatments for hydrofluoric acid burns: a blind controlled experimental study. J Toxicol Clin Toxicol. 2002;40(7):861-866. [Context Link]
7. Mathieu L, Nehles J, Blomet J, Hall AH. Efficacy of hexafluorine for emergent decontamination of hydrofluoric acid eye and skin splashes. Vet Hum Toxicol. 2001;43(5):263-265. [Context Link]
Online information trap
After reading, "Can You Find Reliable Information About EOL on the Internet?" (Transitions: Issues in Palliative and End-of-life Care, March, 2013),* particularly the mention of "quacks and shysters" on the Internet, I recalled a personal experience. Ten years ago, my father was diagnosed with stage IV anal cancer and asked me to help him find online resources about extending his life expectancy. Searching the Internet to find information for him, I was appalled at what was available to unsuspecting, desperate people like my father. I realize that oncologists provide accurate information to newly diagnosed patients; however, I'm certain that some patients, like my father, can't process or understand that information. I urge nurses employed at these institutions to provide patients with websites that contain realistic and accurate information.
-SANTIAGO NOGUE, MD AND MONTSERRAT AMIGO, RN
Barcelona, Spain
-LILLIAN LEVESQUE, BSN, RN
Converse, Tex.
* Individual subscribers can access articles free online at http://www.nursing2013.com. [Context Link]