The Management of Toxic Trauma from Vesicant Agents

5 The Management of Toxic Trauma from Vesicant Agents 

Almost 100 years after the first use of mustard gas (HD) in warfare, there is stiU no available antidote, although there is an antidote (British anti-Lewisite) to the vesicant Lewisite, an arsenical compound developed in 1919. Treatment is therefore based on early recognition of the exposure and immediate decontamination to prevent further injury. This is particularly important in the case of the eyes. 

The previous chapter detailed the toxidrome recognition of exposure to HD. This is based on (1) eye signs, (2) respiratory signs and (3) skin signs. 

The eye is the organ most vulnerable to exposure to HD and which requires the earliest possible attention. The signs and symptoms of HD exposure are related to the concentrations of exposure. These concentrations are unlikely to be known to emergency medical responders but are presented in Box 8.9 as an illustration of the dose dependency. 

NB In considering vapour exposure, 100 mg min m is equivalent to 0.0017 mg/L for 1 h. It should be noted that the odour threshold for HD is 0.0013 mg/L therefore, there is considerable risk of ocular incapacitation at levels that would be difficult to detect by smeU. 

---