Chemical Attack
General Guidance
Diagnosis: Be alert to the following
1. Groups of individuals becoming ill around the same time.
2. Sudden increase of illness in previously healthy individuals.
3. Sudden increase in the following non-syndromes:
- Sudden unexplained weakness in previously healthy individuals
- Dimmed or blurred vision
- Hypersecretion syndromes (like drooling, tearing, and diarrhea)
- Inhalation syndromes (eye, nose, throat, chest irritation; shortness of breath)
- Burn-like skin syndromes (redness, blistering, itching, sloughing)
4. Unusual temporal or geographic clustering of illness (for example, patients who attended the same public event, live in the same part of town, etc.)
Understanding exposure -
1. Exposure may occur from vapor or liquid droplets and, less likely, contamination of food or water.
2. Chemical effects are dependent on:
- volatility and amount of chemical
- water solubility (higher solubility leads to more mucosal and less deep lung deposition and toxicity)
3. increased fat solubility and smaller molecular size increase skin absorption
Decontamination Considerations
1. Chemical warfare agents usually require removal of clothing and decontamination of the patient with soap and water.
2. Treating contaminated patients in the emergency department before decontamination may contaminate the facility.
Agent - Nerve Agents
Symptom Onset - Vapor: seconds, Liquid: minutes to hours
Symptoms
Moderate exposure - Diffuse muscle cramping, runny nose, difficulty breathing, eye pain, dimming of vision, sweating, diarrhea
High exposure - The above plus sudden loss of consciousness, flaccid paralysis, seizures
Decontamination - Rapid disrobing, Water wash with soap and shampoo
Agent - Cyanide
Symptom Onset - Seconds to minutes
Symptoms - almond-like smell
Moderate exposure - Dizziness, nausea, headache, eye irritation
High exposure - Loss of consciousness
Decontamination - Clothing removal
Agent - Blister Agents
(Sulfur Mustard)
Symptom Onset - 2 to 48 hours
Symptoms -Skin erythema, Blistering, Conjunctivitis and lid swelling, Upper airways sloughing, Pulmonary edema, Marrow suppression with hymphocytopenia
Decontamination - Clothing removal, Large amounts of water
Agent - Pulmonary Agents
(phosgene, etc.)
Symptom Onset - 1 to 24 hours (rarely up to 72 hours)
Symptoms - Shortness of breath, Chest tightness, Wheezing, Mucosal and dermal irritation and redness
Decontamination - None usually needed
Agent - Ricin
(castor bean toxin)
Symptom Onset - 18 to 24 hours
Symptoms
Ingestion - Nausea, diarrhea, vomiting, fever, abdominal pain
Inhalation - Chest tightness, Coughing, Weakness, Nausea, Fever
Decontamination - Clothing removal, Water rinse
Agent - T-2
(mycotoxin)
Symptom Onset - 2 to 4 hours
Symptoms - Dermaland mucosal irritation, Blistering, Necrosis, Blurred vision, Eye irritation, Nausea, Vomiting and diarrhea, Altaxia, Coughing and dyspnea
Decontamination - Clothing removal, Water rinse