Chemical Agents and Treatment Protocols Flashcards
1
Q
what is a chemical attack
A
The purposeful use of chemical substance to harm people, cause economic or property damage or instill fear or panic.
2
Q
severity of a chemical attack
A
- toxicity + concentration
- concentration variable
- chemicals that vaporize are less toxic
- wind
- volatility
3
Q
decontamination
A
-you must make sure the patient is decontaminated before treatment
-remove all chemicals and clothing
-
4
Q
if you see something say something
A
-someone should investigate
5
Q
personal protection
A
- time- spend the least amount of time in the area -> less exposure
- distance- put distance between you and incident or have PPE -> less exposure
- shielding- wear the appropriate PPE
6
Q
accidental exposure
A
- blot- blot off the agent
- strip- removing all clothing (80% of decontamination)
- flush- flush the affected area with large amount of water
- cover- cover the affected area- reduce exposure or infection
7
Q
physiological effect of chemical warfare
A
- overstimulation- seizures, twitching -> confusion
- unaware of surroundings
- dizzy
- nervous system is affected
- can last for 2-6 weeks
- constriction of airways - you can get air in but no air out -> trouble breathing, high blood pressure
- excessive mucus -> suction
8
Q
affects on vagus nerve
A
- simulates vagus nerve -> lowers heart rate
- cardiac arrest
- brain damage within 5 minutes
- lowered blood pressure
9
Q
choking agent
A
-chlorine gas
-prevent breathing
-pulmonary edema - fluid in lungs
-
10
Q
herbicide
A
- agent orange
- used to damage vegetation
- vietnam war- damage the foliage
- no hiding
11
Q
blister agents
A
- causes blisters
- can be in the airways too
- eyes can be affected
- can last 2 hours
12
Q
riot control
A
- law enforcement
- irritates eyes
- not meant to cause severe damage
- pepper spray
- if you spray someone with COPD or asthma it can be serious
- tear gas
13
Q
blood agents
A
- cyanide- organ cells cant take up the oxygen
- affects the way the body can use oxygen
- affects the hemoglobin -> cant pick up oxygen
- CO poisoning - hemoglobin cant pick up oxygen
14
Q
nerve agents
A
- chlorine gas
- sarin gas
- blisters
- difficulty breathing
- fluids coming out everywhere- SLUDGEM
- tabun
- soman
- cyclosarin
- seizures
- paralysis
- confusion
- vomiting
- pinpoint pupils **
15
Q
SLUDGEM
A
- salvation - fluids
- lacrimation
- urination
- defecation
- gastroenteritis
- emesis- vomiting
- miosis- pupil constriction
16
Q
pathophysiology of nerve agents
A
- agent binds with ACh
- ex. sarin binds with ACh constantly
- Acetylcholine releases constantly -> overstimulation -> Seizures, secretion of fluids
17
Q
tokyo subway attack
A
- leader created his own religion
- when you joined you sign off your wealth -> rich
- experiments with nerve agents
- used sarin gas in bags in the subway
- use umbrellas to puncture the bags
- 13 people died
- this disrupts the economy, the public, in mass amounts
- so easily available and yet instills fear, death, pain
18
Q
treatment: nerve agents
A
- decontamination
- ventilation
- administration of antidotes
- supportive therapy
19
Q
nasal cannula
A
- 1-6 LPM (liters per minute)
- delivers 24-40% oxygen
20
Q
nonrebreather mask
A
- 8-15 LPM
- delivers 90% of oxygen
- more difficulty of breathing-
21
Q
bag mask valve (BVM)
A
- 15 LPM
- delivers up to 100% oxygen
- when someone cannot ventilate themselves
- lung size depends on height
- issue comes in when you start over inflating -> pneumothorax
- meant to be used by two people- bc cramping
- add a filter to decrease spread of germs
- put on mask then attach bag
22
Q
peep valve
A
- red cap on a BVM
- increases pressure so when you squeeze the bag it keeps pressure within the system (if you have a good seal)
- when you have built up fluid the alveoli will open up and STAY open*
- helps with bringing oxygen in when fluid is present
- o2 doesn’t move easily in fluid but CO2 does
23
Q
continuous positive airway passage mask (CPAP)
A
- asthma attack
- opens the airways
- used on someone is exposed to a chemical
- maintains the pressure
- opens alveoli
24
Q
Bilevel positive airway pressure (BiPAP)
A
- for people that are tired
- tired of breathing
25
endotracheal tube
-gold standard of airway management
26
Igels
-you dont need to look into the airway to be intubate
| -
27
auto-injector
- atropine/pralidoxime combination- injects at same time
- 1. atropine- inject first
- 2. pralidoxime- inject second
28
atropine
- anticholinergic -> blocks acetylcholine receptors
- chemicals have nothing to bind to
- initial dose- 2 mg
- muscle relaxer
- mydriasis
- for people with hypersalivation or large amount of fluids
- comes from atropa belladonna (Nightshade)
- onset: Minutes after
- IV administration
- Duration: 3-5 minutes
29
pralidoxime
- 600 mg dosage
- attaches to nerve agent receptor
- doesnt allow it to bind to ACh
- nerve agent has nothing to attach to
- less effective if aging present (bond between ACh and nerve agent is strong and hardened)
30
diazepam
- valium
- benzodiazepine
- 10mg IV/IM- dosage
- seizure history
- anticonvulsant, hypnotic
- motor cortex- planning, control and voluntary movement
- onset- (IV 1-5min)
- onset- IM 15-30 min
- (PR) Varied
- Duration: (IV) 15 min-1 hour; (IM) 15 min-1 hour; (PR) Peak concentration 1.5 hour
31
midazolam
- aka Versed- before a procedure or anesthesia to cause drowsiness, decrease anxiety, and cause forgetfulness of the surgery or procedure.
- Class: Benzodiazepine
- Initial dose: 1-2 mg IVP or 5 mg IM/IN
- Anticonvulsant
32
supportive care
-
33
benzodiazepine
- lowers respiration rate
| - must be careful
34
suffolk county protocol
- adult patients- > 15 years
- for patients who exhibit signs or symptoms of organophosphate or nerve agent exposure
- ensure scene is safe and you have correct PPE
- triage after gross decontamination
- contact emergency department - number of patients, nature of exposure
- start triage
- provide airway support
- for asymptomatic patients- decontaminate, monitor
- for mild / moderate exposure- give antidote
- for severe exposure- administer all antidotes(duos)
- monitor and reassess
- repeat until patient is not secreting
35
suffolk county protocol: CHEMPACK Program
- hospitals listed below are referred to as SPOKE HOSPITALS -> they do not have chempack stored at the facility but are fed by a specific pre-determine HUB HOSPITAL
- chempack assets are for treatment of NERVE AGENT/ORANGOPHOSPHATE EXPOSURE and include:
- mark 1 auto-injectors
- atropine for IV use
- pralidoxime for IV use
- diazepam autoinjectors
- diazepam for IV use
- atropen auto-injector
- sterile water
36
cyanokits
- cyanide poisoning
- block ability to use oxygen
- form a vitamin B12
- binds to cyanide to create cyanocobalamin -> not toxic to the body
- 5g max of 10 g over 15 min IV
37
cyanokits
- cyanide poisoning
- block ability to use oxygen
- form of vitamin B12
- binds to cyanide to create cyanocobalamin - which is not harmful to the body
