PPE if possibility of contamination
A-SCBA c TECP (Totally-encpasulated Chemical Protection) Suit
B-SCBA or SAR (supplied air respirator) and non-encapsulated chemical resistant suit
C-Skin protection of B c respirator
D-Universal Precautions
Liquid Exposure requires Decon, vapor does not. Decon c water then soap then 0.5% hypochlorite solution, conveniently prepared by mixing 1 part 5% hypochlorite (household bleach) with 9 parts water. Do not use hot water, aids in absorbtion
Nerve Agents
G Series for German
Tabun (GA)-13 hour aging
Sarin (GB)-5 hour aging, most volatile
Soman (GD)-2 minute aging
Cyclosarin (GF)
V Series
VX-most lethal, low volatility, very lipophilic.Oily liquid designed to remain on clothes and surfaces much longer than other agents. 48 hour aging
Binary-just means stored as 2 components to limit handling risk
GB2
VX2
All agents penetrate through skin and clothing, heavier than air
Liquid or Vapor Exposure
Liquid-sx in 30 minutes to 18 hours depending on degree of exposure
Vapor-sx in seconds to minutes
Resp-hypersecretion and in higher doses respiratory shutdown
CV-tachycardia or bradycardia depending on nicotinic or muscarinic predominance
CNS-decreased LOC and seizures
Musculoskeletal-weakness then fasiculations then paralysis
Ocular-tearing and in vapor exposure, miosis
Lab tests-Plasma and RBC cholinesterase (more specific), not great tests
Treatment
Atropine for muscarinic 2 mg IV/IM q 2-5 (will not need as high doses as organophosphates). If severe sx make dose 5 mg
Oximes: 2-Pam 1-2 grams IV/IM Q hour (15-25 mg/kg in kids) administered slowly, will not work if aging has occurred
Mark I Kit-2 mg of Atropine and 600 mg of 2-Pam in autoinjectors. Usually need 3 kits per person
If you need to intubate, do not use sux as will get prolonged paralysis
Blistering Agents
Mustards (HD)
Sulfur mustard penetrates into cells causing alkalation of DNA. Effective in warm, moist tissues (regardless of covering by clothes, so suspect if blisters in groin or axilla)
Volatile at higher temps and most effective in vapor form
Sx 4-24 hours post exposure c bullae and especially ocular effects
If not deconed in 2 minutes post-exposure, irreversible binding. Use water then soap then bleach solution
Lewisite (L)
Smells like geraniums
Immediate blisters
Lewisite shock from thirdspacing of fluids
Choking Agents
Cyanides
Incapacitating Agents
Lacrimating Agents
Vomitting Agents
Irritant Agents
Phosgene (CG)
Smells like freshly cut hay
Denser than air
Pulmonary toxicity prevails along c hemolysis
Decon, steroids, NAC
Chlorine
First eye and oropharynx symptoms (tearing, sore throat, runny nose) then pulmonary toxicity
Nebulized Bicarb (2.5 cc Syringe Bicarb diluted 1:1 with saline) and steroids
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