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7/29/2019 Chemical Agents and Mass Casualties
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Chemical Agents andMass Casualties
Sabeer Mohamed MEM PGY
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Objectives
Introduction
Hazardous Materials Exposure Limit Guide
Hazardous Materials Scene Response
ED Hazardous Materials Response
High Risk Chemicals and types
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Introduction
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Hazardous Materials Exposure Limit
Guidelines
American Conference of Governmental Industr
Hygienists
National Institute of Occupational Safety and
Health
Environmental Protection Agency-three-tieredAcute Exposure Guideline Level (AEGL)
AEGL 1 discomfort
AEGL-2 -irreversible, long-lasting effects
AEGL-3 -serious disease or death
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INDIAN SCENARIO
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Hazardous Materials Scene Response Community Risk Assessment
Recognition of an Event
Identification of the Substances Involved
Isolation and Scene Control
Hot Zone
Warm ZoneCold Zone
Decontamination in the Warm Zone
Stabilization and Triage in the Cold Zone
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ED Hazardous Materials Response
Exposure determines decontamination
Decontaminate one patient at a time
Decontamination outside of the ED
Sufficient equipment for multiple personnel
Effective decontamination-disrobing, brushing &
washing face.
Warm water -universal decontamination fluid
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CONTINUED
After decontamination -hospital clothing-
followed by triage
Irrigation of eyes - sterile normal saline
contaminated wounds will additional irrigation
Radiation survey sweep
Staff -annual training and practice drills
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High Risk Chemicals
TOXIC GASES
Displacement of Oxygen from Air
Irritant Gases - Interrupt Pulmonary Diffusion
Interrupt Oxygen Transport
Interfere with Cellular Oxygen Utilization
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TOXIC GASES
Displacement of Oxygen from Air: Simple Asphyxiants
inert gases - carbon dioxide, hydrogen, nitrogen
noble gases -helium, neon, argon, krypton, xenon, radon
simple hydrocarbons -methane, butane, propane
Restoration of FIO2-with supplemental oxygen
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TOXIC GASES
Irritant Gases - Interrupt Pulmonary Diffusion
Classified according to water solubility
Highly water soluble
Ammonia, sulfur dioxide , hydrogen chloride, hydrogen flu
Intermediate water soluble-chlorine
hydrochloric and hydrochlorous acids
Minimal water soluble-phosgene
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TOXIC GASES
Agents that Interrupt Oxygen Transport
Carbon monoxide & methylene chloride -carboxyhemoglobin
Nitrites, benzocaine, phenazopyridine -divalent Fe2+ to trivalent
methemoglobin
High concentrations o2
Methylene blue -electron donor
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TOXIC GASES
Interfere with Cellular Oxygen Utilization
interfere with oxygen utilization -ETC in mitochondria
cyanide, hydrogen sulfide, phosphine, and sodium azide
headache, altered consciousness, seizures, & severe acido
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TOXIC GASES
Cyanide antidote kit-
perles of amyl nitrite, induce methemoglobinem
ampule of sodium nitrite
ampule of sodium thiosulfate- stimulate the conversion of c
sodium thiocyanate
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NERVE GASES Tabun,sarin,soman
Organophosphates
Inhibit acetylcholinesterase
bind to acetylcholinesterase in a two-stage process
1
ST
reversible with the antidote pralidoxime (2-PAM)
2ND (aging process) makes the enzyme unavailable
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NERVE GASES
SLUD syndrome at muscarinic sites
muscular fasciculation ,muscular weakness, complete paraly
neuromuscular junction/ nicotinic receptor
coma and seizures-brain
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NERVE GASES
Atropine -muscarinic effects.
2-PAM -nicotinic effects.
Benzodiazepines enhance atropine and stop seizures
Avoid succinylcholine-prolongs duration
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Biotoxins
Botulinum Toxin
Antitoxin early
only prevent progression of symptoms
cannot reverse paralysis
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Biotoxins
Ricin
castor bean, Ricinus communis/destruction of RNA
inhalation exposure-pulmonary edema ,necrotizing pneum
parenteral administration-weakness , flu-like symptoms,
nausea, vomiting, fever, localized lymphadenopathy
hypotension, leukocytosis, DIC, multi-organ system fail
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Biotoxins
Staphylococcal Enterotoxin B
Superantigen produce cascade effect -through T-cell stimulation
Respiratory symptoms
Treatment is supportive
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THANK YOU
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