Chemical Agents and Treatment Protocols

Question 1

what is a chemical attack

Answer 1

The purposeful use of chemical substance to harm people, cause economic or property damage or instill fear or panic.

Question 2

severity of a chemical attack

Answer 2

• toxicity + concentration
• concentration variable
• chemicals that vaporize are less toxic
• wind
• volatility

Question 3

decontamination

Answer 3

-you must make sure the patient is decontaminated before treatment
-remove all chemicals and clothing
-

Question 4

if you see something say something

Answer 4

-someone should investigate

Question 5

personal protection

Answer 5

• 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

Question 6

accidental exposure

Answer 6

• 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

Question 7

physiological effect of chemical warfare

Answer 7

• 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

Question 8

affects on vagus nerve

Answer 8

• simulates vagus nerve -> lowers heart rate
• cardiac arrest
• brain damage within 5 minutes
• lowered blood pressure

Question 9

choking agent

Answer 9

-chlorine gas
-prevent breathing
-pulmonary edema - fluid in lungs
-

Question 10

herbicide

Answer 10

• agent orange
• used to damage vegetation
• vietnam war- damage the foliage
• no hiding

Question 11

blister agents

Answer 11

• causes blisters
• can be in the airways too
• eyes can be affected
• can last 2 hours

Question 12

riot control

Answer 12

• 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

Question 13

blood agents

Answer 13

• 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

Question 14

nerve agents

Answer 14

• chlorine gas
• sarin gas
• blisters
• difficulty breathing
• fluids coming out everywhere- SLUDGEM
• tabun
• soman
• cyclosarin
• seizures
• paralysis
• confusion
• vomiting
• pinpoint pupils **

Question 15

SLUDGEM

Answer 15

• salvation - fluids
• lacrimation
• urination
• defecation
• gastroenteritis
• emesis- vomiting
• miosis- pupil constriction

Question 16

pathophysiology of nerve agents

Answer 16

• agent binds with ACh
• ex. sarin binds with ACh constantly
• Acetylcholine releases constantly -> overstimulation -> Seizures, secretion of fluids

Question 17

tokyo subway attack

Answer 17

• 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

Question 18

treatment: nerve agents

Answer 18

• decontamination
• ventilation
• administration of antidotes
• supportive therapy

Question 19

nasal cannula

Answer 19

• 1-6 LPM (liters per minute)

- delivers 24-40% oxygen

Question 20

nonrebreather mask

Answer 20

• 8-15 LPM
• delivers 90% of oxygen
• more difficulty of breathing-

Question 21

bag mask valve (BVM)

Answer 21

• 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

Question 22

peep valve

Answer 22

• 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

Question 23

continuous positive airway passage mask (CPAP)

Answer 23

• asthma attack
• opens the airways
• used on someone is exposed to a chemical
• maintains the pressure
• opens alveoli

Question 24

Bilevel positive airway pressure (BiPAP)

Answer 24

• for people that are tired

- tired of breathing

Question 25

endotracheal tube

Answer 25

-gold standard of airway management

Question 26

Igels

Answer 26

-you dont need to look into the airway to be intubate

-

Question 27

auto-injector

Answer 27

• atropine/pralidoxime combination- injects at same time
• 1. atropine- inject first
• 2. pralidoxime- inject second

Question 28

atropine

Answer 28

• 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

Question 29

pralidoxime

Answer 29

• 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)

Question 30

diazepam

Answer 30

• 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

Question 31

midazolam

Answer 31

• 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

Question 32

supportive care

Answer 32

-

Question 33

benzodiazepine

Answer 33

• lowers respiration rate

- must be careful

Question 34

suffolk county protocol

Answer 34

• 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

Question 35

suffolk county protocol: CHEMPACK Program

Answer 35

• 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

Question 36

cyanokits

Answer 36

• 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

Question 37

cyanokits

Answer 37

• cyanide poisoning
• block ability to use oxygen
• form of vitamin B12
• binds to cyanide to create cyanocobalamin - which is not harmful to the body