Chemical Warfare AgentsAnna Healey, MD PGY-24/30/2014
Objectives
Warfare history
Qualities of chemical agents
Classes of chemical agents
Management of exposures
Decontamination and protection
Chemical Warfare in History
Poisoned spears and arrows
Peloponnesian War: burning wood and sulfur to create noxious smoke to stall the Athenians
World War I: over 50k tons of gases used, causing 1.3 million deaths
Syrian Conflict
http://www.cnn.com/video/?/video/world/2014/04/21/tsr-dnt-labott-syria-new-chemical-weapons.cnn&video_referrer=http%3A%2F%2Fwww.cnn.com%2Fvideo%2Fdata%2F2.0%2Fvideo%2Fworld%2F2014%2F04%2F21%2Ftsr-dnt-labott-syria-new-chemical-weapons.cnn.html%3Fhpt%3Dhp_t2
Qualities to Consider
Individuals vs. population
Detectable vs. undetectable
Persistent vs. non-persistent
Volatility
Method of distribution (solid, liquid, gas)
System affected (nerve, respiratory, mucous membrane, blood)
Classes of Agents
Nerve agents
Asphyxiants/blood agents
Vesicant/blister agents
Choking/pulmonary agents
Tear agents
Cytotoxic agents
Nerve AgentsMain effects on nicotinic and muscarinic receptors via acetylcholinesterase inhibition
Inhalation or absorption through skin
Signs/symptoms: SLUDGE, killer Bs, seizures, muscle fasciculations
Rx: atropine/2-PAM
Examples:Sarin
Insecticides/pesticides
VX
VR
Nerve Agents
https://www.youtube.com/watch?v=doytZVNltc4
Asphyxiants
Arsine: causes hemolysis
Cyanogen chloride/hydrogen cyanide, carbon monoxide: blocks oxidative phosphorylation
Generally via inhalation
Signs/symptoms: confusion, nausea, altered mental status, lactic acidosis, cherry red skin, seizures
Vesicants/Blister Agents
Acid-forming agents that affect mucous membranes and skin; also respiratory tract
Cause large blisters with secondary effects, skin/eye/mucous membrane irritation, respiratory distress/failure
Examples:Mustard gas
Lewisite
Choking/Pulmonary Agents
Also acid-forming, but work primarily in respiratory tract
Cause respiratory irritation with cough, dyspnea, sore throat, bronchospasm, suffocation
Examples:Chlorine gas
Phosgene
Nitrogen oxides
Hydrogen chloride
Tearing Agents
Tear gas and pepper spray
Temporarily incapacitating with stinging of eyes and blurred vision
Cytotoxic Agents
Biological proteins that inhibit protein synthesis
Ricin and abrin
Inhalation, ingestion, or injection
Exposurelatent periodflu-like illness
Pulmonary edema, dyspnea, GI hemorrhage, kidney and liver failure
Management of Exposures
PERSONAL PROTECTION
DECONTAMINATION
SUPPORTIVE CARE
Specific antidotes:Nerve agents—atropine/2-PAM
Asphyxiants—Cyanokit
All others—no antidote
PPE Presentation