Exposure supportive therapy

Drugs Available Yes. (Ciprofloxacin, Doxycycline, and Penicillin), although such drugs are usually not effective after symptoms are present. Supportive therapy may be necessary. Oral ciprofloxacin can be used for known or imminent exposure. 

There is no proven treatment for smallpox, but in persons exposed to smallpox who do not show symptoms as yet, the vaccine — if given within four days after exposure — can lessen the severity of or even prevent illness. However, once a patient shows symptom, treatment is limited to supportive therapy and antibiotics to treat bacterial infections. Patients with smallpox can benefit from supportive therapy such as intravenous fluids, and medicines to control fever or pain. 

Nerve agent intoxication requires rapid decontamination to prevent further absorption by the patient and to prevent exposure to others, ventilation when necessary, administration of antidotes, as well as supportive therapy. Skin decontamination is not necessary with exposure to vapor alone, but clothing should be removed to get rid of any trapped vapor. With nerve agents, there can be high airway resistance due to bronchoconstric-tion and secretions, and initial ventilation is often difficult. The restriction will decrease with atropine administration. Copious secretions which maybe thickened by atropine also impede ventilatory actions and will require frequent suctioning. For inhalation exposure to nerve agents, ventilation support is essential. 

The choice of appropriate treatment for nerve agent intoxication depends on the agent as well as extent and route(s) of exposure. Very mild exposure to nerve agent vapor may necessitate only decontamination and observation severe exposure to vapor or liquid requires immediate decontamination, antidote administration, artificial respiration, monitoring, and supportive therapy over hours to multiple days (ATSDR, 2007 Sidell, 1997 Vale et al, 2007 Pulley and Jones, 2008). Convenient triage classifications have been developed by ATSDR (2007) in collaboration with the US Army Medical Research Institute of Chemical Defense. 

Medical management of nitrogen mustard exposure is similar to that for sulfur mustard and involves prevention of exposure and, where exposure has occurred, decontamination and support therapy. The use of antioxidants in the treatment of nitrogen mustard toxicity is currently under investigation (Hardej and Billack, 2006). 

The onset of toxicity after cyanide poisoning is very fast. The prognosis of the victim depends on termination of further exposure, supportive care, and institution of immediate and aggressive specific treatment. Early diagnosis and clinical information would enhance the chances of recovery. The first principle of therapy is termination of further exposure, which can be facilitated by the following (a) remove the victim from the contaminated atmosphere. 

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. 

Individuals overexposed to isopropanol should be removed from exposure, affected areas of the skin should be washed with soap and water, and the eyes should be irrigated with water. Isopropanol is rapidly absorbed from the gastrointestinal tract. Efforts to decrease absorption are unlikely to be beneficial. Severe isopropanol overdoses have been managed successfully with either peritoneal dialysis or hemodialysis. Since the vast majority of patients respond completely with only supportive therapy, dialysis (hemodialysis much more effective than peritoneal) should be instituted in those patients with a history and physical exam consistent with a very large ingestion (blood isopropyl alcohol >400 mg dl ), those patients with hemodynamic instability (hypotension) and coma. 

The victim should be removed from exposure. Exposed skin and eyes should be thoroughly flushed with tepid water. Supportive therapy should be provided. 

Supportive therapy should be provided for all patients with Frunus exposures. Activated charcoal... 

Most cases of unintentional thiazide overdoses can be managed safely at home as serious effects are not expected. Thiazides and related agents are adsorbed by activated charcoal and it may be used for substantial recent exposures. Because cathartics can also cause fluid and electrolyte losses, their use should be avoided. Fluid status, electrolytes, and EKG should be monitored. Standard supportive therapies with attention to replacement of fluid and electrolyte losses should be utilized as clinically necessary. No antidote is available. Drug levels are not readily available and are not helpful in assessing toxicity. 

The primary treatment of vesicant exposure is decontamination and supportive therapies there is only one vesicant that has an antidote. The paucity of the treatment options continues to confer their tactical advantage. The development of an ameliorative or antidote would accomplish, at a minimum, two goals (1) effective treatment, if needed, and (2) decreased tactical advantage. 

The principles of care for a casualty with nerve agent intoxication include termination of exposure, maintenance of ventilation, administration of antidotes, and supportive therapy. For successful medical management, early and intense therapy after severe exposure to nerve agents is necessary to prevent death. The condition of the patient will dictate the need for specific treatment procedures and the order of administration. It is of utmost importance that medical care providers are protected from contamination by use of appropriate protective clothing, otherwise they may become additional casualties. ... 

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