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MultiSystems > CBRNE - PowerPoint Highlighted Text > Flashcards

CBRNE - PowerPoint Highlighted Text Flashcards

1
Q

hellebore roots thrown into water supplying water to enemy troops by soldiers

A

chemical terrorism - hx ex

similar to digoxin - caused cardiac dysarythmias

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2
Q

belladonna plants to cause disorientation in enemy troops

A

chemical terrorism - hx ex

an anticholingergic that turned them into DUMBBBELLS

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3
Q

chlorine gas in trench warfare

A

chemical terrorism - hx ex

chlorine gas is heavier than air and sank into the trenches; above the trench, the solider would be shot

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4
Q

phosgene filled shells fired at french and british forces

A

chemical terrorism - hx ex

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5
Q

saddam hussein orders Ali Hasa al-Majid to use mustard against Iran and Kurds

A

chemical terrorism - hx ex

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6
Q

ISIS has used mustard gas

A

chemical terrorism - hx ex

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7
Q

Novichok nerve agent A-234 to poison Russian officers

A

chemical terrorism - hx ex

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8
Q

Nerve
Blistering (vesicants)
Blood
Choking (pulmonary)

A

type of chemical agents used to kill

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9
Q

Riot-control agents

Psychochemical

A

type of incapacitating chemical agents

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10
Q

How are nerve agents toxic

A

inhibition of AChE at the NMJ

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11
Q

nicotinic cholinergics are…

A

neuromuscular

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12
Q

muscarinic cholinergics are…

A

neuroglandular

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13
Q

Nerve agents are similar to ____ poisoning

A

organophosphate

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14
Q

Most likely nerve agent at risk for human toxicity on a large scale and is very potent

A

organophosphorous esters (organophosphates)

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15
Q

common warfare nerve agents

A

G-agents (sarin, tabun, soman)

V-series (VX)

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16
Q

Nerve agents are prone to ____

A

aging

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17
Q

what’s aging

A

an irreversible bond between an organophosphate and AChE –> permanent stimulation of the receiving neuron

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18
Q

What warfare nerve agent has a particularly rapid aging process

A

soman

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19
Q

clinical manifestations of nerve agents that cause muscarinic effects

A

DUMBBBELLS: diaphoresis, urinary incontinence, miosis, bronchorreha, bronchospasm, bradycardia, emesis, lacrimation, loose stools, salivation

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20
Q

clinical manifestations of nerve agents that cause nicotinic effects

A

MTWHF: mydraisis, tachycardia, weakness, HTN, fasciculations

nervous system based: weakness, HTN, hyperglycemia, local/generalized muscle fasciculations
tachycardia
mydriasis

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21
Q

what are the three killer B’s of muscarinic nerve agents

A

B: bronchorrhea
B: bronchospasms
B: bradycardia

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22
Q

aum shinrikyo

A

nerve agent: sarin gas in 1995

bioterrorism agent: anthrax in 1994 in Tokyo

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23
Q

Death occurs with VX (nerve agent) within _____ and effects are nearly _____ if VX is _____ and is ______

A

Death occurs within an hour or two and effects are nearly instantaneous if VX is gaseous and is inhaled

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24
Q

Medical management of nerve agents

A

ABCDD: airway, breathing, circulation, decontamination, drugs

prevent becoming a casualty yourself

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25
Q

best agent for decontamination

A

soap and water

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26
Q

how do you handle the airway in nerve agents

A

aggressive airway management including suctioning

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27
Q

what agent must you avoid during a nerve agent exposure intubation

A

succinylcholine: prolongation of normal duration of effect due to current nerve agent exposure having the same effect already

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28
Q

antidote for muscarinic nerve agent exposure and MOA

A

atropine: dries them up!

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29
Q

antidote for nicotinic nerve agent exposure and MOA

A

pralidoxime chloride (2-PAM) to release muscular paralysis (Miosis Tachyardia Weakness HTN Fasciculations)

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30
Q

antidote for seizures during nerve agent exposure

A

BZN: midazolam is fastest acting

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31
Q

4 blistering agents that cause skin burns with blistering

A

nitrogen mustards
sulfur mustards
lewisite
phosgene oxime

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32
Q

blistering/vesicants tends to exert most damage on ____

A

actively proliferating cells such as basal epidermal cells, hematopoietic cells, mucosal lining of intestines

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33
Q

what is the dormancy period of blistering agents after exposure

A

4 - 12 hours

however, if more agent exposure, the latency shortens

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34
Q

garlic/horseradish odor

A

sulfur mustard blistering agent

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35
Q

mustard, onion, asphalt odor

A

sulfur mustard blistering agents

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36
Q

fishy ordor

A

nitrogen mustard blistering agents

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37
Q

no odor or fruity odor

A

nitrogen mustard blistering agents

38
Q

string of pearls distribution overlying a normal, but severely damaged skin

A

mustard blistering agents

39
Q

is mustard blistering agents lethal?

A

not usually, but serious permanent damage occurs, esp. to eyes

40
Q

geraniums odor

A

lewisite blistering agent

41
Q

what blistering agent causes immediate pain to exposed areas of the body?

A

lewisite

mustards take 4 - 12 hrs

42
Q

antidote for lewisite

A

british anti-lewisite (BAL) in peanut oil solution

43
Q

conditions that require systemic tx in lewisite exposures

A

cough with SOB + frothy sputum (pulmonary edema)

skin burn >1% (size of palm)

skin contamination with immediate skin damage (dead/gray-white blanching) or erythema

44
Q

when do you decontaminate with blistering agents

A

1-2 minutes post exposure to prevent further/increasing tissue damage

45
Q

military/terrorist cyanides of interest (2)

A

hydrogen cyanide

cyanogen chloride

46
Q

blood agents

A

cyanide agents

47
Q

how do blood agents works

A

combine with ferric ion and inhibit electron transport chain to convert the body from aerobic metabolism to anaerobic metabolism

48
Q

anaerobic effects of blood agents on the body

A

lactic acid buildup

high anion gap metabolic acidosis

progressive tissue hypoxia with potential cellular death

49
Q

most sensitive organs to blood agent toxicities

A

heart and CNS

50
Q

peach kernels odor

A

hydrogen cyanide

51
Q

bitter almonds odor

A

hydrogen cyanide

even though 40% of population cannot smell almonds

52
Q 
clinical manifestations of \_\_\_\_:
HA
nausea
vertigo
complete recovery
A

small exposure to hydrogen cyanide

53
Q 
clinical manifestations of \_\_\_\_:
HA
nausea
vertigo
seizures or coma
A

moderate exposure to hydrogen cyanide

54
Q 
clinical manifestations of \_\_\_\_:
rapid and deep breathing
violent convulsions
cessation of respiration
cardiac arrest/death
A

serious exposure to hydrogen cyanide

happens in a few minutes

55
Q

burnt fireworks odor

A

cyanogen chloride

56
Q

pungent biting odor

A

cyanogen chloride

57
Q

amyl nitirite and sodium nitrite:

what does it treat
what does it do

A

TREAT: cyanide poisoning

DO: causes methemoglobinemia and binds to the cyanide ion in the electron transport chain to remove it from the chain

58
Q

sodium thiosulfate:

what does it treat
what does it do

A

TREAT: cyanide poisoning

DO: enhances conversion from cyanide to thiocyanate and binds cyanide irreversibly so that it cannot renter mitochondria/get into ETC; renally excreted

59
Q

hydroxycobalamin:

what does it treat
what does it do

A

TREAT: cyanide poisoning

DO: reacts with cyanide ion to form cyanocobalamin (B12) and water to be renally excreted

60
Q

how to correct metabolic acidosis of blood agents

A

sodium bicarb

61
Q

what’s the therapeutic approach to treating blood agents

A

supportive care

62
Q

in comparison to carbon monoxide, what can help with cyanide poisonings

A

oxygen! can make it easier to kick off the cyanide

63
Q

cyanide and the ETC

A

cyanide binds to the cytochrome oxidase, uncouples mitochonidral oxidative phosphorylation, inhibits cellular respiration, and induces anaerobic metabolism = lactic acid

64
Q

choking agents (2)

A

phosgene

chlorine gas

65
Q

least dangerous of the chemical weapons

A

choking agents: phosgene and chlorine gas

66
Q

newly mown or musty hay odor

A

phosgene choking agent

67
Q

interesting fact about phosgene

A

requires refrigeration

68
Q

____ + water = HCl and CO

HCl causes epithelial damage, necrosis of bronchial/bronchioalr/capillary membranes

A

phosgene

this is how phosgene is toxic: hydrolysis method

= non-cardiogenic pulmonary edema

69
Q

two toxic chemical methods of phosgene

A

hydrolysis

acylation

70
Q

phosgene reacts with functional groups on proteins, carbohydrates, lipids to cause severe oxidative damage

results in depletion of glutathione, increased cytokines, and acute lung injury

A

acylation toxicity of phosgene

71
Q

upper airway sx of lacrimation, cough, bronchoconstriction

lower airway exposure gives acute lung injury

A

chlorine toxicity

72
Q

chlorine and airway water results in

A

HCl, hypochlorous acid, oxygen free radicals

73
Q

how does chlorine kill

A

pulmonary edema

74
Q

riot control agents are AKA

A

tear gas
lacrimators
harassing agents

75
Q

oleoresin capsicum

A

law enforcement pepper spray

76
Q

riot control agents are designed to…

A

produce a sensory irritation and severe discomfort that is quick onset, short duration, and high safety (non lethal)

77
Q

results of riot control agents are like…

A

having allergies/SLUDGE

78
Q

how to treat riot agents

A

supportive, help remove clothes/contact lenses

79
Q

psychochemical agents (5)

A 
fentanyl
sufentanyl
LSD (lysergic acid diethylamide)
scopolamine
psilocybin
80
Q 
ergot rye
plague
smallpox
anthrax (powered envelopes)
dengue
slamonella enteritides
A

bioterrorism agents

81
Q

ricin 1978

A

georgi markov - bulgarian political exile that received a subQ injection of ricin via an umbrella tip

82
Q

agents that are easily aerosolized, infective, high mortality rate, can cause panic and social disruption are category ___ agents

A

A

83
Q

ex of category A (5)

A 
anthrax (bacillus antrhacis)
botulinum toxin (c. botulinum)
plage (y. pestis)
smallpox (variola major)
tularemia (f. tularenis)
84
Q

woolsorter’s disease

A

anthrax

85
Q

anthrax spores are

A

highly resistant to drying, heat, gamma radiation, UV light, and disinfectants

can remain dormant for up to 40 yrs

86
Q

anthrax infection occurs in one of four ways

A

injection
inhalation
ingestion
contact with broken skin

87
Q

anthrax toxin that causes skin problems, inhibits neutrophils, impairs immune system

A

edema toxin –> causes edema!

88
Q

anthrax toxin that causes a systemic reaction and can lead to death

A

lethal toxin

89
Q

ABX effect on eschars of cutaneous anthrax

A

do not alter course of eschar (appearance, scabbing, sloughing) but can prevent systemic infection

90
Q

mortality rate of inhalation anthrax

A

85 - 90%

MultiSystems (3 decks)

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