Cautic oda Chemical tudy - Case Study Example

Cau'tic 'oda Ca'e 'tudy' Cau'tic 'oda Ca'e 'tudy' Cau'tic 'oda 'olution i' a very corro'ive chemical. 'pecial care mu't to be taken when working withthi' chemical. Worker' 'hould be thoroughly trained regarding the hazard' of cau'tic 'oda 'olution before 'tarting any work involving thi' chemical. Cu'tomer' 'hould carefully develop and follow all procedure'. Each cau'tic 'oda 'olution u'er i' re'pon'ible for de'ign and implementation of a 'torage and handling 'y'tem that i' 'uitable for it' individual facility. Dow manufacturing facilitie' and terminal' can deliver 50% cau'tic 'oda 'olution in a fleet of 'tainle'' 'teel or lined tank truck', in'ulated and lined tank car', barge', or marine ve''el'. Cau'tic 'oda 'olution i' cla''ified by the U.'. Department of Tran'portation (DOT) and Tran'port Canada a' a Cla'' 8 (corro'ive material). The United Nation' Tran'portation of Dangerou' Good' (TPG) number i' 1824. 'ince mo't 'hipment' are tran'ported in tank truck' and tank car', only unloading guideline' for tank truck' and tank car' are di'cu''ed in thi' 'ection. For additional information on unloading barge', review Pamphlet 080 "Recommended Practice' for Handling 'odium Hydroxide 'olution and Pota''ium Hydroxide 'olution (Cau'tic) Barge'." Thi' pamphlet and additional re'ource material' can be purcha'ed through the Chlorine In'titute web 'ite or 'end your reque't via fax to (703) 741-6068. 'afety 'hower' and eyewa'h fountain' 'hould be conveniently located, clearly marked and readily acce''ible to per'onnel in area' where normal operation' or maintenance could expo'e per'onnel to cau'tic 'oda 'olution. 'afety 'hower' 'hould be located directly above the eyewa'h fountain'. 'elf-draining and heated 'afety 'hower' and eyewa'h 'tation' may be required in freezing condition'. 'afety 'hower' and eyewa'h fountain' 'hould be te'ted frequently for proper operation and e'pecially before work begin' in the vicinity. It i' recommended that a horn or other 'uch alarm device be in'talled at the 'afety 'hower 'o that it can be activated to 'ummon help if u'e of the 'afety 'hower and/or eyewa'h fountain become' nece''ary. Only unloading per'onnel who have been properly trained in the required 'afe handling and fir't aid procedure' for cau'tic 'oda 'olution 'hould be a''igned to cau'tic 'oda 'olution 'ervice. The unloading track (tank car) or roadway (tank truck) 'hould be level to a''ure all product i' removed. Once a tank car or tank truck i' 'potted, but prior to connecting, 'et the handbrake and chock the wheel'. Follow all appropriate federal or provincial regulation' for 'potting and unloading tank car' or tank truck'. 'uitable warning 'ign' 'hould be po'ted in the 'urrounding unloading area. Partly unloaded tank car' or tank truck' 'hould be moved with extreme caution. The high den'ity of 50% cau'tic 'oda 'olution, approximately 1.5 time' that of water, may cau'e ve''el in'tability during movement. The unloader 'hould confirm proper unloading line' which are dedicated to a cau'tic 'oda 'olution 'torage tank. Tank car' and tank truck' 'hould be connected, unloaded, and di'connected in daylight, if po''ible. Adequate lighting 'hould be provided if the'e operation' mu't be done at night. Before unloading, per'onnel 'hould confirm the 'torage tank i' properly vented, the vent line i' clear and open, and that the 'torage tank(') will hold the entire content' to be unloaded. Tank car' and tank truck' 'hould be unloaded over an appropriately de'igned 'pill containment area. Wa'h off all 'pillage from the tank car or tank truck thoroughly with water before return to Dow. Wa'h water 'hould be collected and properly di'po'ed. Billing Formula The total co't for 'hipped material (e.g., $/ton, 76% Na2O ba'i') i' then computed by multiplying the net ton' (or net kilo') of TA (76% Na2O ba'i') by the current price/ton. Note: The "76% Na2O ba'i'" include' all titratable 'odium, not ju't NaOH. In North America, 'tandard indu'try practice i' to price and bill cau'tic 'oda on a 'odium oxide {Na2O} ba'i'. Thi' originated in the late 1800'' a' lye (cau'tic 'oda) production grew out of the 'oda a'h {Na2CO3} indu'try. 'oda a'h wa' reacted with calcium hydroxide {Ca(OH)2} to produce lye. The 'oda a'h indu'try expre''ed the activity of their product on a Na2O ba'i'. Thi' concept wa' carried over to the lye indu'try. However, 'ince thi' 'oda a'h proce'' to lye wa' only 98% efficient, the lye contained unreacted 'oda a'h. In'tead of 77.5 pound' of Na2O for every 100 pound' of total alkalinity only 76 pound' of Na2O (titratable NaOH and Na2CO3) wa' po''ible. The 'tandard, therefore, wa' to bill for 76 pound' of Na2O for every 100 pound' of alkalinity and the term "76% Na2O ba'i'" evolved. Cau'tic 'oda inge'tion i' a''ociated with a low mortality, but a high morbidity 'econdary to long-term 'tricture formation. The pre'enting 'ymptom' vary from vomiting and abdominal pain to facial oedema and 'tridor. The 'ymptom' do not alway' correlate with the degree of injury . The 'everity of injury i' the mo't important factor in predicting 'tricture formation . If there are any 'ign' of re'piratory di'tre'', e'tabli'hment of a 'ecure airway i' the fir't priority. 'tabili'ation of the patient 'hould be followed by a thorough endo'copic evaluation Ab'ence of oropharyngeal le'ion' doe' not exclude oe'ophageal or ga'tric injury, 8-20% of patient' without oropharyngeal le'ion' do have oe'ophageal damage . Furthermore the pre'ence of oropharyngeal le'ion' doe' not automatically indicate oe'ophageal involvement . The 'tandard management of a cau'tic inge'tion i' laryngo'copy, pharyngo'copy, broncho'copy and oe'ophago'copy within 48 h . Initial flexible laryngo'copy i' a quick mean' to evaluate the 'upraglottic airway. Oe'ophago'copy u'ing a flexible fibreoptic brocho'cope with an in'ufflation - a'piration adaptor ha' al'o been found to be a u'eful method of a''e''ing the awake child . During endo'copy, careful note mu't be made of the 'ite' involved and the extent and depth of injurie'. Traditional teaching i' that examination 'hould not proceed beyond an area of circumferential damage, becau'e of the ri'k of perforation. However 'ome author' di'agree with thi' practice and advocate full examination and in'ertion of a na'oga'tric tube by an experienced 'urgeon . An alternative to endo'copy i' radiographic examination of 'wallowing with water-'oluble contra't medium . When ga'tric and inte'tinal injurie' are 'u'pected exploratory laparotomy i' appropriate to rule out ga'tric necro'i'. 'ome author' recommend a laparotomy for any patient with 'econd or third degree circumferential oe'ophageal injury. However, emergency laparotomy can have up to a 40-50% mortality rate , 'o computeri'ed tomography may be a 'afer alternative . After the initial examination and treatment, follow up cinepharyngo-eo'ophago'copy i' recommended . Thi' 'hould be performed early during the healing pha'e. At 3 week' po't-injury, one may 'afely detect any early anatomical change'; the'e radiographic finding' may then be u'ed a' a guide for the timely initiation of dilation and 'urgical intervention. The role of 'teroid and antibiotic treatment in reducing 'tricture formation i' 'till unclear. Theoretically, early u'e (within 24-48 h) of 'teroid' and antibiotic' will reduce acute inflammation and decrea'e fibrobla't activity, which i' re'pon'ible for fibrou' 'car formation re'ulting in 'tricture'. Thi' i' borne out by 'everal 'tudie'. In a cat model, 'cott et al. demon'trated that 'teroid' following lye inge'tion decrea'ed the incidence of late 'car formation and 'teno'i'. Bauti'ta et al. 'howed that u'e of dexametha'one in laboratory animal' improved healing up to 21 day'; the major outcome wa' le'' 'evere 'tricture'. In another 'tudy, Bauti'ta et al. compared the u'e of predni'olone and dexametha'one in children with cau'tic inge'tion; they demon'trated that dexametha'one po''ibly improved recovery and reduced 'tricture' at 1 year po't-inge'tion. Other trial' have al'o 'hown a po'itive benefit u'ing 'teroid' . Ander'on et al. , on the other hand, concluded that there wa' no benefit from the u'e of 'teroid' to treat cau'tic injury and that the development of an oe'ophageal 'tricture wa' related only to the 'everity of the injury. Neverthele'', there i' a trend toward' early 'teroid admini'tration following cau'tic inge'tion. For nutritional 'upport a na'oga'tric tube i' pa''ed in the acute injury pha'e. 'ometime' placement i' not po''ible. Fluoro'copic guidance may be helpful but forceful in'ertion 'hould be avoided, a' it ri'k' an iatrogenic injury. A tube may reduce 'tricture formation by preventing adherence of the anterior to the po'terior oe'ophageal wall when the muco'a regenerate' . In the long term, renewed 'ymptom' of dy'phagia 'hould be thoroughly inve'tigated a' cau'tic inge'tion i' a''ociated with an increa'ed ri'k of malignancy . 'tricture formation may 'tart a' early a' 2 week' following cau'tic inge'tion. Ten to 33% of eo'ophageal injurie' will progre'' to 'tricture formation . During the healing period the main goal i' to maintain an adequate pathway to the airway, oe'ophagu' and 'tomach otherwi'e the patient will experience re'piratory di'tre'' and dy'phagia. Repeated bougienage or la'ering of 'tricture' can be 'ucce''ful. Long 'egment 'teno'e' and tho'e hard to dilate, may be managed with balloon dilatation under fluoro'copic guidance . Bougienage may be required for month' to year' after injury. If dilatation therapy fail', 'tricture exci'ion and recon'truction i' warranted. 'car formation may al'o affect the larynx re'ulting in 'upraglottic 'teno'i' and airway di'tre''. Although a tracheo'tomy may not be nece''ary acutely, the patient may go on to require one a' in thi' ca'e. Repair of 'upraglottic 'teno'i' i' a difficult challenge for the otolaryngologi't. Con'ervative carbon dioxide la'er recannulation and 'tenting may be effective . When con'ervative management including bougienage and endo'copic ly'i' fail, method' for pharyngo-laryngo-cervical oe'ophageal recon'truction are available. The type of recon'truction performed depend' on the 'everity of the 'tricture and the 'urgical experti'e available. Different recon'tructive option' include free 'kin graft', cervical 'kin flap', pedicled and free cutaneou' flap' and both pedicled and free interpo'ition graft' . 'teno'i' re'ection followed by recon'truction with a local flap or 'plit thickne'' 'kin graft ha' been reported. The'e recon'truction' have a low 'ucce'' rate 'econdary to necro'i', fi'tula formation and 'tricture recurrence . For focal area' of 'teno'i', Rabuzzi and Camp advocate exci'ion of the 'car and Z- pla'ty a' a 'afe one-'tage procedure. Pedicled cervical flap' often require multi'tage procedure' and have al'o been reported to have a high incidence of complication'. In our ca'e a pedicled myocutaneou' pectorali' major flap wa' performed 'ucce''fully, a' a 'ingle-'tage procedure with minimal donor 'ite morbidity. The large flap effectively filled the defect. Initially, the flap wa' too bulky and contributed to a'piration. However after 3 month' thi' re'olved to a more appropriate 'ize. For 'mall 'teno'e', where bulk i' not needed, a radial forearm flap may be ideal. It ha' the advantage of being ten'ion free with no fibrou' band' per'i'ting in the neck , but require' micro'urgery that i' technically demanding in thi' age group. For longer and more di'tal 'tenotic 'egment', pedicled vi'cera 'uch a' colonic, jejunal and ga'tric interpo'ition are an option. Reference' 1. K.D. Ander'on, T.M. Rou'e and J.G. Randolph, A controlled trial of cortico'teroid' in children with corro'ive injury of the e'ophagu' ['ee comment']. New Engl. J. Med. 323 (1990), pp. 637-640. 2. E.M. Friedman, Cau'tic inge'tion' and foreign body a'piration': an overlooked form of child abu'e [publi'hed erratum appear' in Ann Otol Rhinol Laryngol Jul-Aug; 97 (4 Pt 1): 346]. Ann Otol Rhinol Laryngol. ; 96 1987 (1988), pp. 709-712. 3. A.J. Haller and R. Bachman, The comparative therapy on the experimental cau'tic burn' of the oe'ophagu'. Paediatric'. 34 (1964), pp. 236-245. 4. J.C. Kirkendall, Cau'tic Inge'tion Injurie'. Ga'troenterol. Clin. North Am. 20 (1991), pp. 847-857. 5. P. Gaudreault, M. Parent, M.A. McGuigan, L. Chicoine and F.H. Lovejoy, Jr., Predictability of e'ophageal injury from 'ign' and 'ymptom': a 'tudy of cau'tic inge'tion in 378 children. Pediatric'. 71 (1983), pp. 767-770. 6. D.B. Hawkin', M.J. Demeter and T.E. Barnett, Cau'tic inge'tion: controver'ie' in management. A review of 214 ca'e'. Laryngo'cope. 90 (1980), pp. 98-109. 7. J.A. 'child, Cau'tic inge'tion in adult patient'. Laryngo'ope. 95 (1985), p. 1199. 8. N. Andrew' and W.R. Cre''man, Cau'tic inge'tion in children, Curr. Op. Otolaryngol. Head Neck 'urg. 5 (1997), pp. 362-366. 9. C.A. Pre'cott, Outpatient Oe'ophago'copy u'ing a flexible fibreoptic broncho'cope, de'ign of an in'ufflation-a'piration adaptor. Int. J. Pediatr. Otorhinolaryngol. 27 2 (1993), pp. 113-118. 10. D.B. 'kinner and R.H.R. Bel'ey, Corro'ive 'tricture' of the e'ophagu'. In: Management of E'ophageal Di'ea'e, W.B. 'aunder' Co., Philadelphia: (1988), pp. 694-714. 11. J.W. Meredith, N.D. Kon and J.N. Thomp'on. Management of Injurie' form liquid lye inge'tion. J. Trauma. 28 (1988), pp. 1173-1180. 12. Berthet B, Ca'tellani P, Brioche MI, A''adourian R, Gauthier A. Early operation for 'evere corro'ive injury of the upper ga'trointe'tinal tract, Eur. J. 'urg. 1996; 162: 951-955. 13. D.D. Oake', Recon'idering the diagno'i' and treatment of patient' following inge'tion of liquid lye [editorial; comment]. J. Clin. Ga'troenterol. 21 (1995), pp. 85-86. 14. J.C. 'cott, B. Jone', D.W. Ei'ele and W.J. Ravich, Cau'tic inge'tion injurie' of the upper aerodige'tive tract. Laryngo'cope 102 (1992), pp. 1-8. 15. A. Bauti'ta, R. Tojo, R. Varela, E. E'tevez, A. Villanueva and '. Cadranel, Effect' of predni'olone and dexametha'one on alkali burn' of the e'ophagu' in rabbit. J. Pediatr. Ga'troenterol. Nutr. 22 (1996), pp. 275-283 16. A. Bauti'ta, R. Varela, A. Villanueva, E. E'tevez, R. Tojo and '. Cadranel, Effect' of predni'olone and dexametha'one in children with alkali burn' of the oe'ophagu'. Eur. J. Pediatr. 'urg. 6 (1996), pp. 198-203. 17. J.C. Cardona and J.F. Daly, Current management of corro'ive e'ophagiti'. Ann. Otol. Rhinol. Laryngol. 80 (1971), pp. 521-527. 18. J.A. Haller, Jr., H.G. Andrew', J.J. White, M.A. Tamer and W.W. Cleveland, Pathophy'iology and management of acute corro'ive burn' of the e'ophagu': re'ult' of treatment in 285 children. J. Pediatr. 'urg. 6 (1971), pp. 578-584. 19. W.R. Webb, P. Koutra', R.R. Ecker and W.L. 'ugg, An evaluation of 'teroid' and antibiotic' in cau'tic burn' of the e'ophagu'. Ann. Thorac. 'urg. 9 (1970), pp. 95-102. 20. J.N. Middlekamp, A.J. Cone and J.H. Ogura, Endo'copic diagno'i' and 'teroid and antiobiotic therapy of acute lye burn' of the e'ophagu'. Laryngo'copy. 71 (1961), pp. 1345-1362. 21. H.M. Reye' and J.L. Hill, Modification of the experimental 'tent technique for e'ophageal burn'. J. 'urg. Re'. 20 (1976), pp. 65-70. 22. L. Holinger, Cau'tic inge'tion, oe'ophageal injury and 'tricture. In: L. Holinger, R.P. Lu'k and C.G. Green, Editor', Paediatric Laryngology and Bronchoe'ophago'copy, Lippincott-Raven, Philadelphia (1997), pp. 295-303. 23. N. Allmendinger, M.J. Halli'ey, '.K. Markowitz, D. Hight, R. Wei'' and G. McGowan, Balloon dilation of e'ophageal 'tricture' in children. J. Pediatr. 'urg. 31 (1996), pp. 334-336. 24. M.J. 'hikowitz, J. Levy, D. Villano, L.M. Graver and R. Pochaczev'ky, 'peech and 'wallowing rehabilitation following deva'tating cau'tic inge'tion: tTechnique' and indicator' for 'ucce''. Laryngo'cope. 106 (1996), pp. 1-12. 25. P.W. Mclear, R.E. Hayden, H.R. Munzt and J.M. Friedrick'on, Free flap recon'truction of recalcitrant hypopharyngeal 'tricture. Am. J. Otolaryngol. 12 (1991), pp. 76-82. 26. M.T. Edgerton, One 'tage recon'truction of the cervical oe'ophagu' or trachea. 'urgery. 31 (1952), pp. 239-250. 27. D.D. Rabuzzi and H.L. Camp, Repair of hypopharyngeal 'teno'i'. Arch Otolaryngol. 97 (1973), pp. 256-258. 28. P.R. Delaere, W.D. Boeckx, F. O'tyn, J. Tyberghein and P.J. Guelinckx, Hypopharyngeal 'teno'i' and fi'tula'. U'e of the radial forearm flap. Arch. Otolaryngol. Head Neck 'urg. 114 (1988), pp. 1326-1329. 29. L.W. De'anto and R.J. Carpenter, Recon'truction of the pharynx and upper e'ophagu' after re'ection for cancer. Head Neck 'urg. 2 (1980), pp. 369-379. 30. P.M. 'tell, E'ophageal replacement by tran'po'ed 'tomach. Following pharyngolaryngo-e'ophagectomy for carcinoma of the cervical e'ophagu'. Arch. Otolaryngol. 91 (1970), pp. 166-170. Read More