Single Contaminated Patient Management - A Case Report

Summary: The management of chemically contaminated patients poses a formidable challenge to the emergency department, necessitating a complex approach to patient care. While the standard emergency medicine training predominantly focuses on clinical topics, the emergence of chemically contaminated cases mandates a comprehensive understanding of management aspects such as suspicion in exposure contexts, decontamination procedures, prevention of personnel contamination, and tailored treatment modalities. In August 2024, a 59-year-old patient was admitted to the Emergency Department (ED) after a workplace accident involving a traumatic impact with a solid object. Upon arrival, the patient was conscious, hemodynamic, and respiratory stable, having as main complaints sudden blindness and pain in the right lower limb, revealing an open fracture of the tibial plateau. A rapid medical history elucidated that the patient had been subjected to exposure from an unidentified container of acid, an incident undisclosed by the pre-hospital team. After a thorough patient history was obtained, the individual was triaged as chemically contaminated, with the contaminant identified as a mix of nitric and hydrofluoric acid. The patient was promptly isolated, decontaminated, intubated, and provided with provisional fracture fixation. This case aligns with existing literature, as most chemically contaminated patients arriving in EDs are exposed due to occupational or accidental household incidents. However, most hazardous materials (HAZMAT) hospital protocols are designed for mass casualty contamination events, requiring extensive human, material, and structural resources. They are often excessive when handling these single-patient cases. The complexity of these protocols makes them hard to use and not practical in overcrowded EDs. Therefore, developing and implementing user-friendly protocols for managing individual HAZMAT patients in the ED would be beneficial. Additionally, regular training should be provided not only for emergency medicine personnel but also for the connecting specialties dealing with these patients, including anesthesiology, surgery, gastroenterology, or ophthalmology.