Pulmonary agents exposure

TABLE 61.6. Management of pulmonary agent exposures (Burklow et al, 2003)... 

Initial physical findings in pulmonary agent exposure may include conjunctivitis, comeal injury, and nasopharyngeal and oropharyngeal injury and edema. Patients may develop stridor and respiratory distress secondary to inflammation of glottic structures, excessive secretions and/or laryngospasm (2,15). 

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. 

Casualties who improve significantly from one or two MARK I kits given for nerve agent symptoms will continue their mission on improvement. Those casualties who later develop symptoms after vesicant or pulmonary agent exposure will seek medical aid either at the unit aid station or at the BAS. Generally, they will decide to seek assistance before the effects become severe, and they will trans-... 

No specific biologic marker/test is available for pulmonary agents as a class however, exposure to bromine might be indicated by detection of elevated bromide levels in serum (reference level is 50-100 mg/L), or if chlorine or bromine is released and they are detected in environmental samples. The case can be confirmed if laboratory testing is not performed because either a predominant amount of clinical and nonspecific laboratory evidence is present or an absolute certainty of the etiology of the agent is known. 

An asymptomatic casualty with known or potential exposure to pulmonary agents. Observe closely and retriage every 2 hours for at least 6 hours before discharge. 

There is no antidote for exposure to these agents. Enforce rest as even minimal physical exertion may shorten the clinical latent period. Asymptomatic individuals suspected of exposure to pulmonary agents should be monitored for possible complications caused by... 

The pulmonary agent phosgene was used extensively as a chemical weapon in WW I. Nowadays, it is an important intermediate for industrial production of insecticides, isocyanates, plastics, aniline dyes and resins, with an estimated yearly production of almost 1 billion pounds. Reliable diagnosis of exposure to phosgene, other than observation of the developing edema by means of chest roentgenology, is not available. 

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. 

Morbidity from pulmonary agents is the direct result of pulmonary edema, appearing 2-4 h after chlorine exposures. Since children have a smaller fluid reserve (Rotenberg and Newmark, 2003), pulmonary edema can cause rapid dehydration or even shock (Burklow et al, 2003). Due to the higher respiratory rates and minute... 

Contents Include pulmonary agents, heavy metals, organics, caustics, corrosives, strong oxldents and reducing agents, microbial hazards, human reproduction and Chemical exposure, and safety programs. 

After exposure to chemical agent vapor, the most important aspect of care is for the soldier to don his mask immediately to prevent further exposure. If the soldier is symptomatic from nerve agent exposure, he should immediately administer the contents of one MARK I kit to himself and notify his buddy of the exposure. For other agents (vesicants, cyanide, and pulmonary agents) there is no self-aid or first-aid therapy. 

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