以前學到的是可以將 gel 放在醫用手套裡面. 請病人戴手套. 讓皮膚可以持續接觸gel
還有就是病患不一定在暴露當下就來掛急診.
氫氟酸的工業用途是酸洗金屬表面. 所以電鍍工廠會用到.
有些病患是在工廠少量持續暴露一整天. 下班才來掛急診
如果是大面積 160 平方公分 (大約13公分正方形)暴露可能導致急性低血鈣. 鈣離子過低除了會造成肌肉痙攣, 感覺異常, 還會引起 QT prolong. 進一步導致心律不整.
(嚴重低血鈣處置另外寫一篇: )
(嚴重低血鈣處置另外寫一篇: )
國科會-科技大觀園-蝕骨水解密：氫氟酸
氫氟酸的用途非常廣泛，不僅是清潔業裡常用的清洗劑，製作不鏽鋼、非鐵金屬的過程中，也用氫氟酸清洗表面含氧化物與鏽蝕物（即酸洗），更是石化製程中重要的催化劑。 值得關注的是，氫氟酸亦是半導體、面板、太陽能電池等產業製程中，用於清洗與蝕刻製程最常用的化學溶液之一。
參考資料-- 下面中文是google翻譯
201602022306HF EXPOSURE TREATMENT GUIDE FOR PHYSICIANS
HF EXPOSURE TREATMENT GUIDE FOR PHYSICIANS
參考資料-- 下面中文是google翻譯
201602022306HF EXPOSURE TREATMENT GUIDE FOR PHYSICIANS
HF EXPOSURE TREATMENT GUIDE FOR PHYSICIANS
University of Southern California Environmental Health and Safety
醫師版-暴露治療指南
簡介
氟化氫是一種高腐蝕性化學品，接觸後會導致嚴重深度燒傷。必須為任何接觸 HF 的人提供醫療援助並立即開始治療。氟化氫與其他腐蝕性化學物質的不同之處在於，氟離子很容易滲透皮膚，導致包括骨骼在內的深層組織層遭到破壞。然而，其嚴重的有害作用來自氟化物（F-）的作用，而不是酸燒傷。HF 中的氟化鐵與骨骼中的 Ca2+ 形成如此牢固的結合。它到達骨骼並從骨骼中濾出鈣，並可能將鈣束縛在神經細胞中。當破壞心臟功能時，這種神經狀況的破壞可能會危及生命。
HF Exposure Treatment Guide for Physicians
Introduction
Hydrogen fluoride is a highly corrosive chemical that can cause severe and deep burns on exposure. It is imperative that medical assistance be provided for any exposure to HF and the treatment be initiated promptly. Hydrogen fluoride differs from other corrosive chemicals in that the fluoride ion readily penetrates the skin causing destruction of deep tissue layers including bone. However, its critical harmful effect comes from the action of the fluoride (F-), not acid burn. Fluoride iron from HF forms such a strong bond to Ca2+ in bones. It reaches to bones and leaches calcium from bones and may tie up calcium in nerve cell. This disruption of nerve condition can be life threatening when disrupting a heart function.
皮膚接觸
局部使用的葡萄糖酸鈣凝膠（2.5%）必須持續塗抹，直至疼痛完全消退。用水徹底（至少 15 分鐘）清洗皮膚後才能使用葡萄糖酸鈣凝膠。疼痛消退後，每隔 3 或 4 小時擦一次葡萄糖酸鈣凝膠，每次 30 分鐘。如果皮膚深度或廣泛燒傷，應將 2.5% 葡萄糖酸鈣凝膠按摩到皮膚上，持續 3 至 4 天，每天 4 至 6 次。應注意塗抹凝膠的人員，尤其是初次塗抹時，應佩戴橡膠手套，以防止皮膚被氫氟酸污染以及可能發生的手部灼傷。
Skin contact
Topically applied calcium gluconate gel (2.5 percent) must be rubbed-in continuously until pain has completely subsided. Calcium gluconate gel should not be used until after complete (at least 15 minutes) washing of the skin with water. After the pain has subsided, the calcium gluconate gel should be rubbed-in for 30 minutes at 3 or 4 hour intervals. If the skin burns are deep or extensive, calcium gluconage gel, 2.5%, should be massaged into the skin for 3 to 4 days, 4 to 6 times daily. Care should be taken to see that personnel who apply the gel, especially on the initial application, wear rubber gloves to prevent skin contamination with HF and possible development of hand burns.
如果皮膚燒傷面積大於 25 平方英寸（160 平方厘米），可能會出現低鈣血症。因此，系統性施用葡萄糖酸鈣可能是必要的。經常監測血清鈣、腎和肝功能是必要的。
In cases where skin burns are greater than 25 square inches (160 cm2) in area, hypocalcemia may be present. Therefore, systematic administration of calcium gluconate may be necessary. Frequent monitoring of serum calcium, renal and hepatic functions is necessary.
當二度或三度燒傷有皮膚穿透跡象時，可採用與註射葡萄糖酸鈣溶液相同的方式，將5%葡萄糖酸鈣溶液（靜脈使用的標準安瓿為10%）注入皮膚和皮下組織。局部麻醉劑。應注意避免過量服用鈣。所有暴露的皮膚都應被滲透，包括該區域周圍 6 毫米（1/4 英寸）的範圍。這可以防止嚴重燒傷的發生。
When there is evidence of skin penetration as in second or third degree burns, a 5 percent calcium gluconate solution (the standard ampule is 10 percent for intravenous use) may be injected by infiltrating the skin and subcutaneous tissues in the same manner as the injection of a local anesthetic. Care should be taken to avoid overdosing with calcium. All skin which has been exposed should be infiltrated including up to ¼ inch (6 mm) around the area. This may prevent the development of severe burns.
指甲周圍的燒傷可能需要將指甲從遠端劈開，以減輕疼痛并促進排水，然後再用上述溶液之一浸泡。
Burns around the fingernail may require splitting the nail from the distal end in order to relieve pain and facilitate draining prior to soaking with one of the above-mentioned solutions.
立即切除用濃縮氫氟酸溶液燒傷的小面積區域可以防止疼痛且癒合緩慢的燒傷。如果有需要的話，切除植皮後進行一期閉合可以提供更快的癒合和更少的疤痕。
Immediate excision of small areas burned with concentrated solutions of HF may prevent a painful, slow-healing burn. Primary closure after excision of skin grafting, if indicated, may provide more rapid healing and less scarring.
眼睛接觸(google翻譯成眼神)
立即用大量水清洗眼睛，同時將眼瞼分開至少 15 分鐘，然後用冰袋敷上。應使用冰袋直至到達醫療機構。此時，應使用1%葡萄糖酸鈣生理鹽水徹底沖洗眼睛5至10分鐘，此後每兩或三個小時滴注葡萄糖酸鈣生理鹽水一次，持續48至72小時。不得使用油或藥膏。使用眼用皮質類固醇溶液可以減少炎症。應立即諮詢眼科專家。
Eye Contact
Immediate washing of the eyes with large quantities of water while holding eyelids apart for at least 15 minutes should be followed by ice packs. The ice packs should be used until a medical facility is reached. Here the eyes should be washed thoroughly with 1 percent calcium gluconate in normal, sterile saline for 5 to 10 minutes, thereafter, calcium gluconate in normal saline should be instilled every two or three hours for 48 to 72 hours. No oils or ointments should be used. Inflammation may be decreased by the use of corticosteroid solutions for ophthalmic use. An eye specialist should be consulted immediately.
蒸氣吸入
應通過面罩或導管向吸入 HF 的人員提供 100% 的氧氣。應盡快通過吸入方式給予他們 2.5% 至 3% 的葡萄糖酸鈣溶液，最好使用霧化器進行間歇性正壓呼吸 (IPPB)，或單獨使用霧化器。應仔細觀察患者有無上氣道水腫伴呼吸阻塞，必要時通過氣管切開或氣管插管維持氣道。
Vapor Inhalation
Persons exposed to HF by inhalation should be given 100 percent oxygen by mask or catheter. As soon as possible, they should be given 2.5 to 3 percent calcium gluconate solution by inhalation, preferably by intermittent Positive Pressure Breathing (IPPB) utilizing a nebulizer, or by nebulizer alone. The patient should be carefully watched for edema of the upper airway with respiratory obstruction and the airway maintained by tracheostomy or endotracheal intubation if necessary.
如果出現肺水腫，應將患者置於呼氣正壓 (PEEP) 的 IPPB 上。應密切監督呼吸系統護理，包括吸入葡萄糖酸鈣。肺部吸收氟離子引起的毒性可能會在肝臟和腎臟中迅速發展，如果血液尿素氮和鉀升高，可能需要採取更有力的控制措施，直至並包括血液透析。支持治療對於所有器官系統都是必要的。
If pulmonary edema develops, the patient should be placed on IPPB with Positive Expiratory Pressure (PEEP). The administration of respiratory care should be very closely supervised, including the administration of calcium gluconate by inhalation. Toxicity from pulmonary absorption of fluoride ion may rapidly develop in the liver and kidneys and may require more energetic measure of control, up to and including hemodialysis, if the blood urea nitrogen and potassium rise. Supportive care is necessary for all organ systems.
食入
根據需要採取急救措施，包括讓患者飲用大量牛奶或添加氧化鎂乳的水。不要催吐。喉嚨燒傷可能會導致嚴重腫脹，需要進行氣管切開術。應將患者送往醫院並仔細觀察。
Ingestion
Apply first aid measures as needed, including having the patient drink a large quantity of milk or water with added milk of magnesia. Do not induce vomiting. Throat burns may cause severe swelling and require a tracheostomy. The patient should be administered to the hospital and carefully watched.
醫療用品
葡萄糖酸鈣凝膠，2.5 %
（強烈建議在工作現場保留商業級葡萄糖酸鈣凝膠以備緊急情況）
葡萄糖酸鈣，1 % 正常無菌鹽水溶液
葡萄糖酸鈣，10 % 用於注射（標準安瓿）。使用等量葡萄糖酸鈣和無菌生理鹽水混合的 5% 溶液。
Medical Supplies
Calcium gluoconate gel, 2.5 %
(Keeping a commercial grade calcium gluconate gel at the work site is highly recommended for an emergency)
Calcium gluconate, 1 % normal, sterile saline solution
Calcium gluconate, 10 % for injecting (standard ampule). Use 5 percent solution mixing equal quantities of calcium gluconate and sterile normal saline.
要製備用於高頻燒傷皮下注射的 5% 葡萄糖酸鈣溶液，請將等量的無菌 10% 葡萄糖酸鈣溶液和無菌生理鹽水混合。
要製備供霧化器吸入的 2.5% 葡萄糖酸鈣溶液，請將一份 10% 葡萄糖酸鈣與三份無菌生理鹽水混合。
25cc 10% 葡萄糖酸鈣加 225cc 生理鹽水 = 1% 滴眼液
To make a 5 % solution of calcium gluconate for subcutaneous injection in HF burns, mix equal amounts of sterile 10% calcium gluconate solution and sterile normal saline.
To make a 2.5% solution of calcium gluconate for inhalation exposure to be given by nebulizer, mix one part of 10% calcium gluconate with three parts of sterile normal saline.
25cc 10% calcium gluconate with 225cc normal saline = 1% eye solution
製備葡萄糖酸鈣凝膠
將定量的 KY Jelly (Johnson & Johnson) 加熱至 50-60oC，通常為 395 克
添加按重量計2.5% 的葡萄糖酸鈣，試劑級，緩慢地充分攪拌直至全部溶解。
Preparation of Calcium Gluconate Gel
Heat a measured amount of K-Y Jelly (Johnson & Johnson) to 50-60oC, typically 395 gram
Add 2.5% by weight of calcium gluconate, reagent grade, slowly with good stirring until all dissolved.
An alternate method of adding the calcium gluconate is to add 2 grams and stir in until mostly dissolved, then add the remaining calcium gluconate (added to 35 cc of H2O)) with good stirring until dissolved into the jelly
透明含有許多氣泡，靜置後可以通過讓氣泡上升到表面來去除
Finished gel will be water-clear with many air bubbles which can be removed by allowing the bubbles to rise to the surface after standing
上述數量將填滿十一個四盎司罐子，大約四分之三滿
The above quantities will fill eleven four ounce jars approximately three quarters full
Additional Information
Article: M.A. Trevino et al, J. Occ. Med., 25, p. 861
Product Information, EI. DuPont De Nemours & Company, 1-800-441-7515 (product) or 3637 (medical assistance)
醫師版-暴露治療指南
簡介
氟化氫是一種高腐蝕性化學品，接觸後會導致嚴重深度燒傷。必須為任何接觸 HF 的人提供醫療援助並立即開始治療。氟化氫與其他腐蝕性化學物質的不同之處在於，氟離子很容易滲透皮膚，導致包括骨骼在內的深層組織層遭到破壞。然而，其嚴重的有害作用來自氟化物（F-）的作用，而不是酸燒傷。HF 中的氟化鐵與骨骼中的 Ca2+ 形成如此牢固的結合。它到達骨骼並從骨骼中濾出鈣，並可能將鈣束縛在神經細胞中。當破壞心臟功能時，這種神經狀況的破壞可能會危及生命。
HF Exposure Treatment Guide for Physicians
Introduction
Hydrogen fluoride is a highly corrosive chemical that can cause severe and deep burns on exposure. It is imperative that medical assistance be provided for any exposure to HF and the treatment be initiated promptly. Hydrogen fluoride differs from other corrosive chemicals in that the fluoride ion readily penetrates the skin causing destruction of deep tissue layers including bone. However, its critical harmful effect comes from the action of the fluoride (F-), not acid burn. Fluoride iron from HF forms such a strong bond to Ca2+ in bones. It reaches to bones and leaches calcium from bones and may tie up calcium in nerve cell. This disruption of nerve condition can be life threatening when disrupting a heart function.
皮膚接觸
局部使用的葡萄糖酸鈣凝膠（2.5%）必須持續塗抹，直至疼痛完全消退。用水徹底（至少 15 分鐘）清洗皮膚後才能使用葡萄糖酸鈣凝膠。疼痛消退後，每隔 3 或 4 小時擦一次葡萄糖酸鈣凝膠，每次 30 分鐘。如果皮膚深度或廣泛燒傷，應將 2.5% 葡萄糖酸鈣凝膠按摩到皮膚上，持續 3 至 4 天，每天 4 至 6 次。應注意塗抹凝膠的人員，尤其是初次塗抹時，應佩戴橡膠手套，以防止皮膚被氫氟酸污染以及可能發生的手部灼傷。
Skin contact
Topically applied calcium gluconate gel (2.5 percent) must be rubbed-in continuously until pain has completely subsided. Calcium gluconate gel should not be used until after complete (at least 15 minutes) washing of the skin with water. After the pain has subsided, the calcium gluconate gel should be rubbed-in for 30 minutes at 3 or 4 hour intervals. If the skin burns are deep or extensive, calcium gluconage gel, 2.5%, should be massaged into the skin for 3 to 4 days, 4 to 6 times daily. Care should be taken to see that personnel who apply the gel, especially on the initial application, wear rubber gloves to prevent skin contamination with HF and possible development of hand burns.
如果皮膚燒傷面積大於 25 平方英寸（160 平方厘米），可能會出現低鈣血症。因此，系統性施用葡萄糖酸鈣可能是必要的。經常監測血清鈣、腎和肝功能是必要的。
In cases where skin burns are greater than 25 square inches (160 cm2) in area, hypocalcemia may be present. Therefore, systematic administration of calcium gluconate may be necessary. Frequent monitoring of serum calcium, renal and hepatic functions is necessary.
當二度或三度燒傷有皮膚穿透跡象時，可採用與註射葡萄糖酸鈣溶液相同的方式，將5%葡萄糖酸鈣溶液（靜脈使用的標準安瓿為10%）注入皮膚和皮下組織。局部麻醉劑。應注意避免過量服用鈣。所有暴露的皮膚都應被滲透，包括該區域周圍 6 毫米（1/4 英寸）的範圍。這可以防止嚴重燒傷的發生。
When there is evidence of skin penetration as in second or third degree burns, a 5 percent calcium gluconate solution (the standard ampule is 10 percent for intravenous use) may be injected by infiltrating the skin and subcutaneous tissues in the same manner as the injection of a local anesthetic. Care should be taken to avoid overdosing with calcium. All skin which has been exposed should be infiltrated including up to ¼ inch (6 mm) around the area. This may prevent the development of severe burns.
指甲周圍的燒傷可能需要將指甲從遠端劈開，以減輕疼痛并促進排水，然後再用上述溶液之一浸泡。
Burns around the fingernail may require splitting the nail from the distal end in order to relieve pain and facilitate draining prior to soaking with one of the above-mentioned solutions.
立即切除用濃縮氫氟酸溶液燒傷的小面積區域可以防止疼痛且癒合緩慢的燒傷。如果有需要的話，切除植皮後進行一期閉合可以提供更快的癒合和更少的疤痕。
Immediate excision of small areas burned with concentrated solutions of HF may prevent a painful, slow-healing burn. Primary closure after excision of skin grafting, if indicated, may provide more rapid healing and less scarring.
眼睛接觸(google翻譯成眼神)
立即用大量水清洗眼睛，同時將眼瞼分開至少 15 分鐘，然後用冰袋敷上。應使用冰袋直至到達醫療機構。此時，應使用1%葡萄糖酸鈣生理鹽水徹底沖洗眼睛5至10分鐘，此後每兩或三個小時滴注葡萄糖酸鈣生理鹽水一次，持續48至72小時。不得使用油或藥膏。使用眼用皮質類固醇溶液可以減少炎症。應立即諮詢眼科專家。
Eye Contact
Immediate washing of the eyes with large quantities of water while holding eyelids apart for at least 15 minutes should be followed by ice packs. The ice packs should be used until a medical facility is reached. Here the eyes should be washed thoroughly with 1 percent calcium gluconate in normal, sterile saline for 5 to 10 minutes, thereafter, calcium gluconate in normal saline should be instilled every two or three hours for 48 to 72 hours. No oils or ointments should be used. Inflammation may be decreased by the use of corticosteroid solutions for ophthalmic use. An eye specialist should be consulted immediately.
蒸氣吸入
應通過面罩或導管向吸入 HF 的人員提供 100% 的氧氣。應盡快通過吸入方式給予他們 2.5% 至 3% 的葡萄糖酸鈣溶液，最好使用霧化器進行間歇性正壓呼吸 (IPPB)，或單獨使用霧化器。應仔細觀察患者有無上氣道水腫伴呼吸阻塞，必要時通過氣管切開或氣管插管維持氣道。
Vapor Inhalation
Persons exposed to HF by inhalation should be given 100 percent oxygen by mask or catheter. As soon as possible, they should be given 2.5 to 3 percent calcium gluconate solution by inhalation, preferably by intermittent Positive Pressure Breathing (IPPB) utilizing a nebulizer, or by nebulizer alone. The patient should be carefully watched for edema of the upper airway with respiratory obstruction and the airway maintained by tracheostomy or endotracheal intubation if necessary.
如果出現肺水腫，應將患者置於呼氣正壓 (PEEP) 的 IPPB 上。應密切監督呼吸系統護理，包括吸入葡萄糖酸鈣。肺部吸收氟離子引起的毒性可能會在肝臟和腎臟中迅速發展，如果血液尿素氮和鉀升高，可能需要採取更有力的控制措施，直至並包括血液透析。支持治療對於所有器官系統都是必要的。
If pulmonary edema develops, the patient should be placed on IPPB with Positive Expiratory Pressure (PEEP). The administration of respiratory care should be very closely supervised, including the administration of calcium gluconate by inhalation. Toxicity from pulmonary absorption of fluoride ion may rapidly develop in the liver and kidneys and may require more energetic measure of control, up to and including hemodialysis, if the blood urea nitrogen and potassium rise. Supportive care is necessary for all organ systems.
食入
根據需要採取急救措施，包括讓患者飲用大量牛奶或添加氧化鎂乳的水。不要催吐。喉嚨燒傷可能會導致嚴重腫脹，需要進行氣管切開術。應將患者送往醫院並仔細觀察。
Ingestion
Apply first aid measures as needed, including having the patient drink a large quantity of milk or water with added milk of magnesia. Do not induce vomiting. Throat burns may cause severe swelling and require a tracheostomy. The patient should be administered to the hospital and carefully watched.
醫療用品
葡萄糖酸鈣凝膠，2.5 %
（強烈建議在工作現場保留商業級葡萄糖酸鈣凝膠以備緊急情況）
葡萄糖酸鈣，1 % 正常無菌鹽水溶液
葡萄糖酸鈣，10 % 用於注射（標準安瓿）。使用等量葡萄糖酸鈣和無菌生理鹽水混合的 5% 溶液。
Medical Supplies
Calcium gluoconate gel, 2.5 %
(Keeping a commercial grade calcium gluconate gel at the work site is highly recommended for an emergency)
Calcium gluconate, 1 % normal, sterile saline solution
Calcium gluconate, 10 % for injecting (standard ampule). Use 5 percent solution mixing equal quantities of calcium gluconate and sterile normal saline.
要製備用於高頻燒傷皮下注射的 5% 葡萄糖酸鈣溶液，請將等量的無菌 10% 葡萄糖酸鈣溶液和無菌生理鹽水混合。
要製備供霧化器吸入的 2.5% 葡萄糖酸鈣溶液，請將一份 10% 葡萄糖酸鈣與三份無菌生理鹽水混合。
25cc 10% 葡萄糖酸鈣加 225cc 生理鹽水 = 1% 滴眼液
To make a 5 % solution of calcium gluconate for subcutaneous injection in HF burns, mix equal amounts of sterile 10% calcium gluconate solution and sterile normal saline.
To make a 2.5% solution of calcium gluconate for inhalation exposure to be given by nebulizer, mix one part of 10% calcium gluconate with three parts of sterile normal saline.
25cc 10% calcium gluconate with 225cc normal saline = 1% eye solution
製備葡萄糖酸鈣凝膠
將定量的 KY Jelly (Johnson & Johnson) 加熱至 50-60oC，通常為 395 克
添加按重量計2.5% 的葡萄糖酸鈣，試劑級，緩慢地充分攪拌直至全部溶解。
Preparation of Calcium Gluconate Gel
Heat a measured amount of K-Y Jelly (Johnson & Johnson) to 50-60oC, typically 395 gram
Add 2.5% by weight of calcium gluconate, reagent grade, slowly with good stirring until all dissolved.
An alternate method of adding the calcium gluconate is to add 2 grams and stir in until mostly dissolved, then add the remaining calcium gluconate (added to 35 cc of H2O)) with good stirring until dissolved into the jelly
透明含有許多氣泡，靜置後可以通過讓氣泡上升到表面來去除
Finished gel will be water-clear with many air bubbles which can be removed by allowing the bubbles to rise to the surface after standing
上述數量將填滿十一個四盎司罐子，大約四分之三滿
The above quantities will fill eleven four ounce jars approximately three quarters full
Additional Information
Article: M.A. Trevino et al, J. Occ. Med., 25, p. 861
Product Information, EI. DuPont De Nemours & Company, 1-800-441-7515 (product) or 3637 (medical assistance)
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