disaster preparedness and terrosim Flashcards
chemical warfare
inentional use of weapons to kill, injure, incapacitate by toxic or noxious chemicals
biologic warfare
inentional use of weapons to kill, injure, or incapacitate by microorgansims/xenobiotics derived from living organisms
Terrorism
force against ppl or property to intimidate or coerce a government, civilian population for political or social objectives
unitary(traditional) vs Binary agents
Unitary agents are effective on their own and do not require mixing with other agents
Binary = the nerve agent is typically stored as two less toxic chemical ingredients that are easier to transport, handle and store.
(NBC) nuclear, biologic and chemical agent
why used?
easy to get and make
small amount needed in enclosed space
chemical terrorism limitations
dose makes the poison
difficult in disseminating the agent for effect on target population
can be hazardous to maker
development and use requires skill
chemical terrorism methods of delivery
explosive release - point source/line source
bulk release -agent spills out into airstream
base ejection - piston action
spray delivery - airplane
3 types of vesicants
mustard - fluid blister, hours later
lewisite - fluid blister, immediate
phosgene oxime - wheal, immediate
what is a vesicant?
blistering agent
causing skin, eye, respiratory and mucosal pain
geranium
garlic
new mown hay
lewisite
mustard-gassed
phosgene
mustard gases
no antidote
1st symptom is coughing
fluid blister
mustard gases treatment
remove clothing
soap and water
resin (SDK)
IV NAC – N-aceytlcytsiene
phosgine oxime
causes like an allergic rxn ( urticant/nettle agent)
Lewisite
organoarsenic compound potent lacrimator inhibits krebs cycle fluid blister geranium smell
lewisite treatment
decontamination
water sufficient
(BAL) British Anti-lewisite aka dimercaprol
phosgene mechanism
slowly hydrolyzed to hydrochloric acid
causes necrosis and inflammation of small airways and alveoli
highly soluble gases
chlorine gas - makes hydrochloric acid and hypchlorous acid when dissolved in water
treatment is nebulized sodium bicarbonate
ABC’s
bronchodilators
no benefit from steroids or antibiotics
highly soluble gas nitrogen dioxide mechanism
and treatment
generates reactive nitrogen intermdieats that damage pulmonary epithelial cells
treatment = supportive care
corticosteroids
methylene blue
highly soluble gas is white phosphorous
combusts when added to O2
can be hydrolyzed to phosphoric acid in tissue
white phosphourous treatment
irrigation of burn and covered with damp cloth
apply 1% copper sulfate to precipitate phosphorous and stops oxidative rxn
hydrogen cyanide mechanism
cytochrome oxidase inhibitor
hydrogen cyanide clinicial effects
unconciousness seizure tachycardia acidosis cardiogenic pulmonary edema acute lung injury
hydrogen cyanide clinicial effects
unconciousness seizure tachycardia acidosis cardiogenic pulmonary edema acute lung injury
hydrogen cyanide treatment
hydroxocobalamin
sodium thiosulfate
nitrites mechanism
makes methemoglobin which cyanide binds preferentially to produce cyanmethemoglobin
sodium thiosulfate
eases conversion of cyanide into thiocyanate via rhodanese
used for impaired oxygen carrying capacity
hydroxocobalamin
vitamin b12 binds with cyanide to make cyanocobalamin
safe to use in setting of smoke inhalaiton
arsenic
tastless
odorless
trivalent arsenic
inhibits krebs cycle by blocking atp production
affects cardiac repolarization currents
inhibits insulin induced glucose transport and damages Beta cells
chronic vascular disease
hepatatic fibrosis
cancer
pentavalent arsenic
transformation to As3+ substitutes for inorganic phosphate uncoupling oxidative phosphyrylation forms adp arsenate rice water diarrhea mutlisystem organ dysfunction
arsenic treatment
supportive care
benxodiasepinez
ivf for fluid loss
chelation
do not wait to chelate in acute toxicity
BAL (dimercaprol) = 1st line for acute toxicity
succimer (DMSA)
antidote for anticholinergics
physostigmine
nerve agents
organophosphates
sarin
cholinergic toxidrome
organophosphates
mechanism inhibits acetylcholinesterase
acetylcholinesterase
enzyme that degrades acetylcholine to choline and acetic acid
found in CNS and PNS and RBC
different nerve agents
g series = non persistent and volatile tabun sarin - most volatile soman cyclosarinn v series = persistence and non volatile or less volatile vx = least volatile vr vm vg ve
nerve agents
most are lipohilic which leads to prolonged release from adipose (tissue absorbs it and leaks it back to blood stream)
seizures loss of conciousness, apnea, and death
confirmed by cholinesterase levels
nerve agents toxidrome
mydriasis
cholinesterase can age because of nerve agents
soma = 2 min sarin = 5 hours tuban = 40 hours
nerve agent antidotes
atropine
benzodiazepines
oximes
sarin gas mechanism
binds to acetylcholinesterase. muscles only flex and the diaphram cramps causing asphyxiation
odorless
colorless
very volatile therefore easily enters lungs
short half life (very hard to detect after long time)
nerve agent antidote
diazapam
2-PAM
atropine
non ionzing radiation
low energy
no electron bumping
UV, visible spectrum, IR
Ionzing
directly ionizing
indirectly ionzing
directly = alpha and beta particles stopped by paper and clothing indirectly = gamma/XR (stopped by several feet of concrete/inches of Pb)
acute radiation syndromes progress through 4 stages in what order?
- hematopoietic syndrome (can possibly survive)
- GI syndrome (not survivable)
- cardiovascular/CNS (not survivable)
- survival or death
higher the dose you move through each system
order of treatment for radiation injury?
- life threatening injuries
- externally contaminated
- internally contaminated
- externally irradiated
biological agents
anthrax plage yersinia pestis tularemia - arobic gram negative coocobaciluus brucellosis - unpastuerized dairy Q fever small pox viral hemorrhagic fevers equine encephalitis botulinum toxin - disrupts SNARE complex and acetylcholine fails to be released to the nmj
treating bioological agents
supportive care
antitoxin; babybig, trivalent, and heptavalent
treatment of ricin
supportive care
no antidote
diagnosis of ricin
elisa assay of nasal swab, blood, or other body fluid
staphylcoccal enterotoxin B
not lethal just incapacitates
what is a super antigen?
activates immune system
leads to strong inflammatory response because of activation of oligoclonal (non-specific) t cell activation
T-2 myctoxin
red rash
yellow rain
strategic national stockpile
nations largest supply of potentially life saving parmaceuticals and medical supplies
chempacks
containers of nerve agent antidotes in secure locations for rapid response
push packages
strategically located ready for immediate deployment
PPE A
breathing apparatus
encapsulated chemical protective suit
highest level of respiratory, eye, mucous membrane and skin protectioin
ppe B
positive pressure respirator
non encapsulated chemical resistant garments
max respiratory protection with lower degree of skin protection
ppe C
same skin protection as B with lower level of respiratory protection
ppe D
hospital universal precautions
inadequate chemical protection
