Additional Notes:

Causes neurological and kidney damage and blindness. Also associated with birth defects. Very damaging to aquatic life. It is found in paint, batteries, thermometers, electrical equipment, fluorescent lights and plastic. Also used in gold mining industry. Batteries accound for 88% of the mercury content in municipal solid waste.

ABC Reminders:

Quickly access for patent airway, ensure adequate respiration and pulse. If trauma is suspected, maintain manually and apply a cervical collar and a backboard when feasible. Adminster supplemental oxygen as required. Assist ventilation with a bag-valve-mask device if necessary. Place on a cardiac monitor.

Evaluate and support airway, breathing and circulation. In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, surgically create and airway.

Treat patients who have bronchospasm with aerosolised bronchodilators. The use of bronchial sensitising agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitising agents may be appropriate; however, the use of cardiac sensitising agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Mercury poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitsing agents. Sympathomimentic bronchodilators in patients exposed to mercury vapor.

Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc wter, repeat every 20 minutes as needed, cautioning for myocardial variability.

Patients who are comatose, hypotensive, or have seizures or ventricular arrhythmias should be treated in the conventional manner.

Fluids should be titrated to maintain acceptable uring output and blood pressure. Care must be taken not to overhydrate the patient.

Basic Decontamination

Victims who are able may assist with their own decontamination. Remove and double-bag contaminated clothing and all personal belongings.

Wash exposed skin and hair with mild soap and water (preferably under a shower). Rinse thoroughly with water. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate.

Flush exposed or irritated eyes with plain water or saline for at least 5 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If pain or injury is evident, continue irrigation while transferring the victim to the Support Zone.

In cases of ingestion, do not induce emesis. Elemental mercury is not readily absorbed from the gastrointestinal tract and generally does not produce acute toxicity from this route of exposure. Activated charcoal is not effective for ingested mercury exposure.

Consider appropriate management of chemically contaminated children, such as measures to reduce separation anxiety if a child is separated from a parent or other adult. If possible, seek assistance from a child separation expert.

Additional Decontamination

Continue irrigating exposed skin and eyes, as appropriate.

In cases of ingestion, do not induce emesis. Elemental mercury is not usually absorbed from the gastrointestinal tract and does not produce acute toxicity from this route of exposure. Activated charcoal is not effective.

Advanced Treatment

In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, perform cricothyroidotomy if equipped and trained to do so.

Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Mercury poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents and sympathomimetic bronchodilators may reverse bronchospasm in patients exposed to mercury.

Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.

Patients who are comatose, hypotensive, or have seizures or cardiac arrhythmias should be treated according to advanced life support (ALS) protocols.

Additional Resources

For further information on human exposure to mercury, please call the Indiana Poison Center at (800) 222-1222. The Poison Center line is staffed 24 hours/day, 365 days/year.
Small spills can usually be cleaned up easily. In most cases, air testing is not necessary. If you are an Indiana resident, you can request air testing from the Indiana State Department of Health (ISDH) Indoor and Radiological Health at (317) 233-7147.

If you need further spill advice or if you have had a big mercury spill, you may call the Indiana Department of Environmental Management (IDEM) Spill Line at (888) 233-7745 or (317) 233-7745. The Spill Line is staffed 24 hours/day, 365 days/year. IDEM personnel will determine if IDEM and/or US EPA Region 5 from Chicago should be called in to perform a more thorough cleanup operation

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