Selected chemicals requiring specific decontamination

Toxin	Classification	Treatment
Bitumen (Tar)	Caustic	Copious irrigation with cold water until bitumen cools and hardens. Bitumen that is adherent to blistered skin should be removed with blister epithelium. Bitumen adherent to unblistered skin should be covered liberally with a hydrocarbon solvent (eg, mineral oil).
Hydrofluoric acid	Caustic with systemic toxicity	Standard decontamination followed by application of 10% calcium gluconate gel. Parenteral calcium administration by injection or venous or arterial infusion may be required. Patient at risk for hypocalcemia.
Lime (calcium oxide)	Caustic	Brush off as much as possible prior to contact with water.
Phenol	Caustic with systemic toxicity	Irrigate with polyethylene glycol (PEG) 400.
Phosphorus (elemental yellow phosphorus)	Caustic	Avoid exposure to air. Copious water irrigation, and keep covered with water.
Radiation	Acute radiation syndrome	Obtain radiation monitoring device. Protect personnel if patient is radioactive. Decontaminate from periphery to center of area of exposure. Avoid creating new breaks in the skin. Allow wounds to bleed freely. Collect urine and feces for signs of internal decontamination.
Reactive metals (eg, elemental sodium, potassium, lithium)	Caustic	Apply mineral oil and remove visible particles with forceps, gauze, or towels, then store removed particles in mineral oil.

NOTE: The treatment protocols given here are theoretically optimal, but decontamination efforts should not be delayed for a significant time to institute them.

Adapted with permission from: King C, Henretig FM (Eds). Skin decontamination. In: Textbook of Pediatric Emergency Procedures, 2nd ed, Lippincott Williams & Wilkins 2008. Copyright © 2008 Lippincott Williams & Wilkins. www.lww.com.

Graphic 70216 Version 12.0

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Selected chemicals requiring specific decontamination