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蘋果日報 寫:2012年12月14日14:34
任清潔工的林姓男子，去年1月遭強酸氫化氟灼傷雙手，先後至中市聯安醫院和台新醫院就診，醫師均依一般化學物灼傷處理，以大量清水沖洗後、上藥包紮，未使用中和劑治療，林男多次就診，手指逐漸發黑潰爛，最後侵蝕見骨。
林男10天後至中國醫藥大學附設醫院就醫，傷處已嚴重壞死，致右大姆指、食指、中指及無名指遭截指，林男不滿醫師延誤病情，向2醫院求償245萬元。
聯安與台新均稱，患者主訴「被化學藥劑燙傷」、「遭強酸燒傷」，均未告知禍首是氟酸，醫師依一般強酸灼傷處理，未違反常規。雖雙方對是否有告知遭「氫氟酸」灼傷各執一詞，但患者已說明受化學物質或強酸灼傷，醫師未主動問強酸種類，以致遲誤治療，法院判2醫院要賠195萬餘元。
WINDOW 寫:第一次聽到「氫氟酸」這名詞
病人講了我也聽不懂
newshine 寫:看完上述新聞後
您對於醫療刑責合理化
還有信心嗎
joeyoung 寫:林男太厲害ㄌ嗎?
知道氫氟酸需要怎麼中和處理
醫生只大量沖水包扎有過失
醫醫相害啦!
hitachi 寫:一個國家發展經濟，可能使用類似「氫氟酸」的毒物有多少??
至少有千種吧!!
能要求「任一位急診醫師」
「熟悉」這千種毒物的解毒方式??
能要求「任一家醫院」
完全準備這些解毒劑??
還是應該要求「使用毒物的工廠自備解毒劑」??
在「毒蛇出沒地區工作的人」應該自己想辦法記住毒蛇的特徵
還是期待醫師「完全猜中」咬你的蛇是那一種??
小弟除了髒話，不知道能給什麼評論……
鬼島爛民，死有餘辜…
大家都沒責任,只有醫師有責任 
newshine 寫:
感謝分享
但是真的能在急診中判定清楚嗎
尤其是連病人都不清楚的時候呢
唉
chienchun 寫:台北榮總急診部 高偉峰醫師
http://www.pcc.vghtpe.gov.tw/old/docms/41004.htm
對氫氟酸中毒病患的處置，如其致病機轉一樣，可分為兩個層面，第一是處理其氫離所產生的酸性灼傷，第二則是處理其氟離子所產生的嚴重傷害。雖然氫氟酸與其他酸性物質作用不盡相同，對氫氟酸中毒病患初期的處置原則，仍與一般強酸灼傷處置雷同。但氟離子所產生的傷害，如未予以治療，可繼續進行持續性的組織破壞，絕不可掉以輕心。尤其氫氟酸暴露初期，病患可能沒有症狀，外表有看不出異常，嚴重的疼痛可能延遲數小時才發生，因此雖然是嚴重的中毒，卻容易被忽視，所以對氫氟酸中毒病患，縱使病患初期沒有症狀，也應予以積極的治療。對於氫氟酸中毒治療主要以鈣與鎂為主，從前對氫氟酸中毒治療的經驗，主要來至葡萄糖酸鈣或氯化鈣的施予，然近來已有越來越多的研究顯示，如硫酸鎂等含鎂的鹽類，似乎比鈣鹽能更安全且有效的治療氫氟酸中毒病患，值得大家參考。
現場及到醫院前之處置
在現場及到醫院前之處置，包括除去污染的衣物、用大量的水沖洗患部(應至少沖水30分鐘)，儘速送醫。對於皮膚接觸者，患部可塗抹葡萄糖酸鈣(Calcium gluconate)或氧化鎂(Magnesium oxide)軟膏，直到疼痛消除為止。在送醫途中並可將患部浸泡在含鈣或鎂的溶液或乳膠中(如可將乳膠灌入手套中，再將受傷害的手戴入手套，以改善灼傷部位與乳膠的接觸)，以繼續結合入侵的氟離子。對口服病患，不要催吐，可給予牛奶、含鈣溶液、含鎂胃乳、鈣片或含鎂胃乳片，以結合有毒氟離子。若潑及眼睛，應立即沖水30分鐘以上，方法是由眼內角往外沖洗，以免傷及另一隻好的眼睛。呼吸道吸入，應先將病患移開污染源，防止繼續吸入，並維持呼吸道暢通，及給予100％氧氣。
leonhong 寫:truelovecoco 寫:「氫氟酸」的中和劑是沙小??
轉轉轉~~~~~~
以前門診碰過幾位手部接觸氫氟酸的化學灼傷患者。 我要好好記下來。0.4.5 DERMAL EXPOSURE
A) OVERVIEW
1) MANAGEMENT OF MILD TO MODERATE TOXICITY
a) Thoroughly irrigate skin immediately after exposure.
Patients with early decontamination do well. Patients
with pain should be treated with topical calcium
therapy. TOPICAL - Treat with calcium gluconate or
carbonate gel (1 g calcium gluconate in 40 g (about 40
mL) water-soluble lubricant = 2.5% gel; alternative is
10 10-g tablets crushed to fine powder + 20 mL
water-soluble lubricant mixed into a slurry; apply
thin coat to burn, then place hand in glove containing
10 mL slurry for 4 hours). SUBCUTANEOUS - Inject 0.5
mL/cm(2) with 10% calcium gluconate for topical
treatment failures (not commonly used).
b) DO NOT USE CALCIUM CHLORIDE - Calcium chloride is
irritating to the tissues and may cause injury.
2) MANAGEMENT OF SEVERE TOXICITY
a) Patients with pain not responding to topical calcium
can be treated with regional venous or arterial
perfusion. These methods are particularly effective
for HF exposures involving the digits. BIER BLOCK -
Inject IV 10 to 40 mL calcium gluconate in 50 mL
normal saline for 20 minutes. ARTERIAL - 10 to 20 mL
of 10% calcium gluconate in 50 mL D5W. Infuse over 4
hours via radial or brachial artery. Ther arterial
catheter may be placed in normal position (not
inverted).
b) DO NOT USE CALCIUM CHLORIDE - Calcium chloride is
irritating to the tissues and may cause injury.
3) DECONTAMINATION
a) PREHOSPITAL: For dermal exposure, remove clothing and
irrigate skin thoroughly with water.
b) HOSPITAL: Irrigate exposed skin. Remove all exposed
clothing and jewelry taking necessary precautions to
prevent secondary exposure to health care providers.
Irrigate exposed areas promptly with copious amounts
of water for at least 30 minutes.
chichang 寫:(失魂) 以前門診碰過幾位手部接觸氫氟酸的化學灼傷患者。
http://toxnet.nlm.nih.gov/ 倒是有不少紀錄可以看
http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~HCcgFX:10.4.5 DERMAL EXPOSURE
A) OVERVIEW
1) MANAGEMENT OF MILD TO MODERATE TOXICITY
a) Thoroughly irrigate skin immediately after exposure.
Patients with early decontamination do well. Patients
with pain should be treated with topical calcium
therapy. TOPICAL - Treat with calcium gluconate or
carbonate gel (1 g calcium gluconate in 40 g (about 40
mL) water-soluble lubricant = 2.5% gel; alternative is
10 10-g tablets crushed to fine powder + 20 mL
water-soluble lubricant mixed into a slurry; apply
thin coat to burn, then place hand in glove containing
10 mL slurry for 4 hours). SUBCUTANEOUS - Inject 0.5
mL/cm(2) with 10% calcium gluconate for topical
treatment failures (not commonly used).
b) DO NOT USE CALCIUM CHLORIDE - Calcium chloride is
irritating to the tissues and may cause injury.
2) MANAGEMENT OF SEVERE TOXICITY
a) Patients with pain not responding to topical calcium
can be treated with regional venous or arterial
perfusion. These methods are particularly effective
for HF exposures involving the digits. BIER BLOCK -
Inject IV 10 to 40 mL calcium gluconate in 50 mL
normal saline for 20 minutes. ARTERIAL - 10 to 20 mL
of 10% calcium gluconate in 50 mL D5W. Infuse over 4
hours via radial or brachial artery. Ther arterial
catheter may be placed in normal position (not
inverted).
b) DO NOT USE CALCIUM CHLORIDE - Calcium chloride is
irritating to the tissues and may cause injury.
3) DECONTAMINATION
a) PREHOSPITAL: For dermal exposure, remove clothing and
irrigate skin thoroughly with water.
b) HOSPITAL: Irrigate exposed skin. Remove all exposed
clothing and jewelry taking necessary precautions to
prevent secondary exposure to health care providers.
Irrigate exposed areas promptly with copious amounts
of water for at least 30 minutes.
轉大廟急診是必然的。
氫氟酸皮膚灼傷很像凍傷的樣子。
