A patient inhaled ammonia and chlorine in a closed room. After assuring your own safety, which should you do first with this patient?

• A. Start an IV NS, then give sequential albuterol treatments.
• B. Transport to the nearest hyperbaric chamber.
• C. Start an IV and administer 3 amps of atropine.
• D. Secure airway and administer 100% oxygen.

Answer: (D)

Irritant gases like ammonia and chlorine can cause rapid airway swelling and severe hypoxemia, so the immediate priority is to secure the airway and maximize oxygenation. Securing the airway prevents obstruction from edema and secretions that can develop quickly, and delivering 100% oxygen ensures the patient receives the highest possible amount of oxygen to treat low blood oxygen levels and support gas exchange as the lungs are irritated and inflamed. Other actions, such as starting IV fluids with bronchodilators or more specialized treatments, aren’t as immediately protective as ensuring the airway and oxygenation first. If signs of ongoing bronchospasm appear, bronchodilators may be used, but they don’t take precedence over establishing a secure airway and high-flow oxygen.