Pulmonary agents decontamination

Animals exposed to volatile pulmonary agents do not require decontamination. If low volatility agent aerosols have been released, animals can be decontaminated with shampoo/soap and water (see Section 10.5.3). If the animals eyes have been exposed to the agent, they should be irrigated with water or saline solution for a minimum of 30 minutes. 

Pulmonary agents pose little risk of direct residual contamination. Wash the remains with soap and water. Pay particular attention to areas where agent may get trapped, such as hair, scalp, pubic areas, fingernails, folds of skin, and wounds. Once the remains have been thoroughly decontaminated, no further protective action is necessary. Body fluids removed during the embalming process do not pose any additional risks and should be contained and handled according to established procedures. Use standard burial procedures. 

After completing decontamination, the only effective management consists of close observation for the development of respiratory distress and supportive care. There are no known antidotes for pulmonary agent exposure. Patients exposed to phosgene or diphosgene require monitoring for a minimum of 12h because of the possibility of delayed symptoms (2). Strict bed rest is essential for patients with mild and moderate exposmes, because any exertion, even minimal exertion, can shorten the clinical latent period and inaease the severity of respiratory symptoms (8). In symptomatic patients, physical activity can cause clinical deterioration and even death (8). Supportive care consists of managing secretions, bronchospasm, hypoxia, and pulmonary edema. 

Discuss specific decontamination and treatment of victims of a pulmonary agent attack. 

If you suspect an attack by a pulmonary agent, you should not enter the scene unless you are wearing at least Level G PPE. Removal of the victims from additional exposure is critical. Those exposed must be decontaminated prior to treatment and transport. Their clothing should be removed as soon as they are out of the area of exposure. Clothing will absorb the agent and off-gas. The patient should... 

While decontamination and supportive therapy are the mainstays of treatment, antidotes to counteract HD vapor, aerosol, or liquid exposures do not exist (Yu et al, 2003). Adult decontamination may include bleach solutions however, this method can cause greater toxicity in children. Soap and water are the preferred agents to use for decontamination in children. Supportive care consists of the management of pulmonary and skin manifestations such as the use of cough suppressants and/or topical silver sulfadiazine for bums (Yu et al, 2003 Sidell et al, 1997 Azizi and Amid, 1990). Pediatric dosage and treatment recommendations for vesicant exposures are displayed in Table 61.5. 

Pediatric exposures to vesicants can be quite toxic however, in contrast to nerve agent exposures, HD causes significantly greater morbidity than mortality. While mustard did not cause many deaths in WWI, death from HD exposure is usually due to massive pulmonary damage complicated by infection (bronchopneumonia) and sepsis. Children often show a quicker onset and greater severity of toxicity. Skin and eye toxicity occurs in the form of blisters or irritation that can result in blindness for the most severe cases. Except for lewisite, vesicant exposures must be managed with supportive care and rapid decontamination. 

For aerosol inhalation, the complete lack of useful clinical experience leaves one to speculate based on animal studies or human poisoning from comparable chemical agents. The first priorities should be immediate evacuation and decontamination to reduce the risks of further exposure or secondary aerosols for the patient and health care provider, combined with providing adequate ventilation and any necessary airway support. Pulmonary edema likely wiU evolve during the 12-36 h following exposure, and this may be amenable to treatment with antiinflammatory drugs, bronchodilators, oxygen, endotracheal intubation, and, in extreme cases, continuous or mechanical supplemental positive end-expiratory pressure (Franz and Jaax, 1997 Audi et al., 2005). 

Concerns about the possible use of chemical agents in acts of terrorism have increased in the decade since the nerve agent Sarin caused a mass casualty incident in the Tokyo subway system. Chemical warfare poisons include nerve agents, vesicants, cyanides, riot control agents, and pulmonary irritants. Presenting symptoms as well as the clinical circumstances may help identify the agent and lead to effeotive treatment as well as proper decontamination. 

Anytime you are called to a mass casualty event in which all patients have pulmonary symptoms, you should not enter the scene or approach victims until the HazMat team has made an investigation. This approach may have to be modified if HazMat is not available within minutes. If you must respond to save lives, you should wear Level B or C PPE, and the patients should be decontaminated before being transported. This toxin will not be detected by chemical agent detectors, so you would suspect either a chemical that is not detectable by current detectors or one of the biological toxins (ricin, staphylococcal enterotoxin B, or mycotoxin T2). 

Any exposure to toxic gases or vapors requires EMS assessment after removal from the laboratory and emergency decontamination. High-flow oxygen and transport to a medical lacffity are indicated. Remember that exposure to some agents such as phosphine may produce delayed problems such as pulmonary edema. Medical evaluation is required for everyone exposed to toxic gases. 

Lewisite (also known as Agent L), is no longer considered a state-of-the-art CW agent. Lewisite is a significant threat to unprotected personnel and causes prompt incapacitation from eye injuries and respiratory irritation, coupled with long-term incapacitation from skin bums, pulmonary injury, and systemic illness. Its decomposition products are toxic, making decontamination difficult. Munitions containing lewisite may contain toxic stabilizers. Lewisite is effective as vapor, aerosol, or liquid (Sidell et al., 1997). 

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