Vesicant agents prevention

Because terrorists are unlikely to announce they are about to release a vesicant agent, there are no effective preventive measures for vesicant exposure. Recognition of the exposure and rapid, effective decontamination of victims is essential to prevent secondary exposure and additional cases. 

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The Japanese Army issued individual decontamination kits to its troops for destroying vesicant agents on the skin. The kit contained powder that formed a paste with water, and absorbent cotton for swabbing the paste on the mustard area. The paste could not be applied as quickly as ointment, since the soldier had to mix the ingredients before use, and this was a vital factor in the tropics where mustard had to be destroyed within a minute or two if burns were to be prevented. Furthermore, a paste had little prophylactic value in contrast to an ointment. ... 

Medical decontamination requires removal or neutralization of CWAs, which upon penefrafion of fhe skin produce vesication or, with OPs, enter the systemic circulation and inactivate ChEs. The most important process for the exposed soldier or civilian is to remove the chemical agent from the skin as quickly as possible. The soldier, under harsh conditions, must use the treatment product quickly to minimize transdermal penetration. A decontaminant that inactivates the chemical agent prevents its penetration through the skin and potentially protects a medical worker or colleague from suffering a secondhand exposure. 

Sulfur vesicants These agents are insoluble in water and form self-protecting decomposition products at the water/agent interface that prevent hydrolysis of the agent. These decomposition products are stable and some of them have toxic and/or vesicant properties. 

Casualties/personnel Speed in decontamination is absolutely essential. To be effective, decontamination must be completed within 2 minutes after postexposure. However, decontamination after the initial 2 minutes should still be undertaken in order to prevent additional percutaneous absorption of the agent leading to systemic toxicity. Remove all clothing as it may continue to emit "trapped" agent vapor after contact with the vapor cloud has ceased. Shower using copious amounts of soap and water. Ensure that the hair has been washed and rinsed to remove potentially trapped vapor. To be effective, decontamination must be completed within 2 minutes of exposure. If there is a potential that the eyes have been exposed to vesicants, irrigate with water or 0.9% saline solution for a minimum of 15 minutes. 

Centers for Disease Control and Prevention. "Case Definition of Vesicant/Blister Agent Poisoning." Interim document, December 22,2003. 

Similar to the mustard agents, exposure prevention is the first line of defense against lewisite. Rapid decontamination is especially relevant to lewisite exposure due to the rapid development of pain (1-2 min) associated with lewisite exposure. Unlike other vesicants, an effective antidote for lewisite toxicity exists in the form of British anti-lewisite (BAL 2,3-dimercaptopropanol) which binds with arsenicals, thereby countering the lewisite-induced damage. Such chelation therapy is associated with notable side effects (e.g. renal effects) and requires carefiil medical management. More effective analogs of BAL have been developed with less significant side effects. 

Future directions appear to focus on acquiring additional in-depth understanding of the mechanism of action of these agents through the development of experimental models for vesicant-induced injury, and an application of this information in the development of therapeutic measures for the prevention and treatment of vesicant-induced injury. 

Daunorubicin (daunomycin, rubidomycin Cerubidine, others) is available for intravenous use. The recommended dosage is 30 to 60 mg/m daily for 3 days. The agent is administered with appropriate care to prevent extravasation, as severe local vesicant action may result. Total doses greater than 1000 mg/m are associated with a high risk of cardiotoxicity. A daunorubicin citrate liposomal product (Daunoxome) is indicated in the treatment of AIDS-related Kaposi s sarcoma. It is given in a dose of 40 mg/m infused over 60 minutes and repeated every 2 weeks. Patients should be advised that the drug may impart a red color to the urine. 

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. 

Although the MINICAM system can detect VX, we were unable to develqi a quantitative penetration cell mediod for VX. The very low equilibrium viqior pressure of VX (0.00063 mm Hg 2S C) (19) prevented reproducible transfer of VX fixim the penetration cell to die MINICAMS detection system. Thus, die only quantitative mechanical module in the DTN for VX is the HS-GC/MS test for VX liquid. Four nanomaterials passed this test (Figure 4). The high correlation of the nanomaterials that passed the HS-GC/MS tests for all diree CWAs (HD, GD, and VX), as well as die penetration cell test for HD and GD, indicates the universal ability of these materials to neutralize both vesicants and nerve agents. 

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