CBR Threats Lecture Powerpoint Flashcards
Weapon of mass destruction definition
Any weapon designed or intended to cause death or serious bodily injury thru release, dissemination, or impact of toxic/poisonous chemicals or their precursors, release radiation or radioactivity at a dangerous level to human life, any weapon involving a disease organism, or an explosive greater than 4 ounces incendiary, poison gas, bomb, grenade, or rocket
Anthrax
Bacteria with protective coating due to its spore so resistant to survival in air, sunlight, soil, and water, delivered by aerosol and near 100% lethal in inhaled form causing 1-6 incubation period followed by flu like symptoms progressing to severe respiratory distress with death, can desporulate as long as 60 days after exposure
Cutaneous antrhax
Vesicular lesion which progresses with ulceration, 20% morbidity with no treatment, not deadly typically
Anthrax decontamination (2)
Sporicidal agent required including chlorine and iodine, vaccine available but limited and required yearly
Anthrax treatment options in adults (2) and children (2)
-Ciprofloxacin
-doxycycline
(2 most common agents, need early treatment, usually inhaled is futile)
- ciprofloxacin
- penG high dose
Cholera
Bacteria causing intestinal rice stool diarrhea infection, often found in wet areas with standing water, does not survive well in air or pure water, delivered via water contamination, food, or fecal oral route, death occurs from dehydration/electrolyte problems
Cholera decontamination (3)
- Vaccine only effective for 6 months
- Decontamination of water
- Hand washing
Plague
Bacteria carried by rodents with transmission directly or by fleas, delivery by infected fleas or aerosol, either 1 of 3 forms either lung pneumonic (bloody sputum), skin bubonic (swollen lymph nodes), or blood borne from either lung or skin as a secodary
Plague decontamination (2)
- vaccine available with booster every 2-3 years
- heat/sun/bactericidals
Plague treatment options (4)
- respiratory isolation mandatory for first 48 hours of treatment
- streptomycin
- doxycycline
- chloramphenicol for meningitis form
Tularemia
Carried by insects and rodents, may be inhaled, delivered via aerosol or infected animals, signs and symptoms see skin ulcers with lymph nodes, fever, headache, flu like symptoms, chest pain, fever, nonproductive cough, weight loss
Tularemia decontamination (4)
- vaccine
- doxycycline as prophylaxis
- heat
- bactericidals
Q fever
Inhaled infection carried by sheep, cattle, and goats, often diagnosed via vets, signs and symptoms from aerosol can be 10-20 days after exposure and not critically ill but incapacitating with fever, cough, chest pain lasting 2-20 days
Q fever treatment options (3)
- vaccine available in australia
- tetracycline within 8-12 days of exposure
- decontamination soap and water and hypochlorite
Smallpox
Virus easily produced, delivered by aerosol, sins and symptoms are fever, headache, vomiting, backache with rash appearing 2-3 days later with pustules on arms and face and signifcant scarring,
Smallpox decontamination (4)
- quarantine 16-17 days or until all lesions scabbed over
- decontamination soap and water
- vaccine available but limited
- respiratory protection
Venezuelan Equine Encephalitis
Mosquito borne disease from equine animals, aerosol delivery in weaponized form, signs and symptoms include fever, aching, severe headache/light sensitivity, (fever differentiates from migraine), nausea and vomiting
Venezuelan Equine Encephalitis (2)
- Investigational vaccine
- Routine disinfectants
Viral hemorrhagic fever
Diverse group of viruses geographically specific, commonality is hemorrhage associated with them, developed by aerosol when weaponized, cause fever, bleeding in skin and internal organs, aching, vomiting, diarrhea, mortality is highest with agents like ebola and zaire
Viral hemorrhagic fever decontamination (2)
- vaccine for yellow fever only
- decontamination of blood and body fluids especially
Viral hemorrhagic fever treatment options (4)
- supportive care
- avoid antiplatelet drugs
- replacement of clotting factors/platelets
- healthcare workers at high risk for needle stick transmission
List of viral hemorrhagic fever viruses (5)
- ebola
- hantaan
- yellow fever
- dengue
- west nile
Botulism
By-product of decayed food that causes neurological effect, when delivered as an aerosol much higher dose required to effect than ingested, generalized weakness, blurred vision, poor speech and swallowing, progressive descending paralysis** are all symptoms
Botulism decontamination (2)
- antitoxin
- water decontamination
Ricin
Protein byproduct of castor beans delivered via aerosol or powder with large quantities needed for aerosol, signs and symptoms are weakness, fever, cough, mediastinal hemorrhage and death in 36-72 hours
Ricin decontamination (2)
- soap and water
- hypochlorite solution (water decontamination)
Staphylococcal enterotxin
Common form of food poisoing that is incapacitating, primarily food borne or from water supply, causes diarrhea nausea and vomiting ingested but aerosol fever chills headache and cough
Staphylococcal enterotoxin decontamination (2)
- public health measures to destroy contaminated food
- soap and water
Mycotoxins exposure signs and symptoms (7)
- itching
- redness
- blistering
- cough
- wheezing
- bloody sputum
- might be mistaken for chemical agent, and important to remember it is the toxin not the agent itself
Mycotoxin decontamination (4)
- soap and water
- eye irrigation
- charcoal ingestion
- protection of inhalation
Nerve agents
Anticholinesterase inhibitors primarily
Vesicants
Agents that cause blistering and will require burn care with pulmonary support
Incapacitating agents
Agent that temporarily prevents an individual from functioning through processes such as blinding, altering mental status, etc
Decontamination of chemical agents (3)
- soap and water
- specific agents for neutralization
- prevention of cross contamination
Blood agents
Poisons absorbed into the blood such as cyanide
Nerve agents signs and symptoms (4) (what do muscarinic agents cause and nicotinic agents?)
- progressive weakness and paralysis
- respiratory distress/arrest
- muscarinic agents affect smooth muscle such as eye, airway, hyperactive GI system (vomiting and diarrhea), endocrine
- Nicotinic agents affect skeletal muscle (fasciculations, twitching, weakness, tachycardia/hypertension)
Nerve agent treatment options (3)
- airway support
- antidote therapy with atropine and pralidoxime chloride (remove agent from acetycholinesterase)
- benzos for seizures associated
Nerve agent decontamination (2)
- soap and water
- secondary contamination considerations with liquid agent exposure
Vesicant agents examples (2)
- mustard
- lewisite
Vesicant agents
Agents that cause vesicles whereever they are exposed (skin, GI, lungs), vapor and liquid threat with latent period between exposure and effects, systemically toxic
Mustard agents most commonly cause ___ and ___ problems, more rarely ____
conjunctivitis and corneal injuries (may be permanent), bone marrow suppression
Mustard agents treatment options (7)
- decontamination
- supportive care
- topical mydriatics/antibiotics for eye
- avoid overhydration
- humidified oxygen
- assisted ventilation
- bronchodilators
Lewisite
Imediate onset of symptoms causing tissue necrosis and increased capillary permeability but no bone marrow suppression
Lewisite treatment options (2)
- emergency decontamination
- BAL antidote
Common incapacitating agents (5)
- irritants such as mace
- psychiatric agents
- anhydrous ammonia
- chlorine
- cyanide
Anhydrous ammonia
Highly corrosive basic agents that cause severe pain with chemical burns as well as if inhaled respiratory
Chlorine
Toxic via production of hydrochloric acid when added to moisture, can cause noncardiogenic pulmonary edema, sudden death in high concentrations, airway management important
Cyanide
Blood agent that affects mitochondria inhibiting ATP production, see individual who is breathing okay but very sick and weak and pink
Cyanide treatment (2)
- lilly kit (3 agents)
- Cyanocobalamin (B12)
Basics of radiation (3)
- chemical free radical damage of DNA very quickly
- biological molecular damage of proteins over hours
- biological damage to tissues over hours to years
Alpha radiation
Easily shielded by skin but problem if inhaled or ingested
Beta radiation
Electron that has fair penetration of tissue
Gamma radiation
Highest penetrating ability thru small pieces of concrete, high energy wave form
Protection from radiation (3)
- time of exposure
- distance from emission
- shielding
Rads
Amount of radiation emitted from source
Rem
Amount of anticipated damage from particular radiation dose absorbed by the human body
LD50 (lethal dose to 50% of population) of radiation
450,000mrem
Acute radiation syndrome
Cellular injury that occurs from exposure >100rads, may have significant long term effects that causes acute symptoms such as nausea vomiting and diarrhea (those that get sick early are going to be more likely to die), latent phase sees decrease in leukocytes and other critical cell populations as result of bone marrow insult, then recovery over weeks or months
The sooner you see changes in WBC counts (dropping quickly) in acute radiation syndrome patients, these patients are higher risk for…
…mortality (not malignancy)
Brain is relatively resistant to radiation exposure, but if exposed, sees….
….Increased intracranial pressure, herniation, and death
