Emergency Preparedness Flashcards
Disaster is defined as
A catastrophic event that leads to major property damage, a large number of injuries, displaced individuals, or major loss of life
- sudden calamity exceed coping of resources
- unforeseen = great destruction and human suffering
- needs external assistance
Natural disaster
hurricanes
tornados
storms
floods
tidal waves
earthquakes
volcanic eruptions
droughts
blizzards
pestilence
famines
wildfires
Human-made disasters
explosions
building collapses
commercial
transportation wrecks
leakage and spills of toxic chemicals
radiation contamination
building fires
etc…
Personal and Family Preparation for a Disaster
- Preparations can be made to deal with those circumstances
- Relief and rescue workers generally arrive quickly after a disaster
- aftermath of all disasters is very similar
Most natural disasters, except for earthquakes and volcano eruptions, have a warning period ranging from
few minutes to several hours
During the time between the occurrence of the disaster and the rescue, individuals are
Left to their own devices and resourcefulness for their survival
The aftermath of all disasters is
similar
- relief and rescue workers arrive quickly but can not take care of all the injured or trapped at the same time
What research should the nurse do prior in disaster management
Find out what disasters the community has experienced in the past. Is it on a fault line and likely to have earthquakes?
Is it located in tornado alley?
When was the last time a wildfire broke out?
There may be some potential man-made hazards associated with the community.
Does it havelarge fertilizer or fireworks plants that may explode?
Is there a large oil or natural gas pipeline that runs under the town?
How old is the freshwater dam that is located upstream from the community?
Virtually impossible to make preparations toavoiddisasters caused by
acts of terrorism and catastrophic human engineering failures
How to make a plan for preparing for a disaster?
Get informed (city layout, weather belt, meeting places for pets and contacts)
- Get an “out-of-town” contact person
- Establish a preselected meeting place
- Have a family communication plan (everyone’s numbers, poison control, local hospitals, close relatives)
- Map out escape routes and safe places (turn of utility
- special plans for disabled
- Make a plan for pets (take with if able
What needs to be included in a disaster supply kit?
- Basics
- Inventory of all home possessions
= this can be done by taking pictures or a video of the inside of your house with focus on big items - Laminate and copies of records and documents
- Insurance coverage
= homeowner insurance does not cover floods/earthquakes - How to turn off utilities
In the event of a disaster, you should have basic supplies for how long?
72 hours
Disaster Supply Kit
airtight plastic bags (plastic bins or duffel bags)
Water/water filter
Nonperishable food
Radio (battery or hand crank)
Flashlight
First-aid Kit
Extra batteries (outside the devices
Matches/candles
change and dollars not big bills
Extra dry clothes
Whistle
Space blanket
Weapons
Dust Mask, Plastic sheets, and duct tape
Moist towelettes, garbage bag
Wrench/pliers
Manuel can opener
Local maps
Chargers and back up batteries
Water
one gallon of water per person per day for at least three days, for drinking and sanitation
During the Preimpact Phase, what is critical?
communication
Preimpact Phase
- some have warnings (tornados, hurricanes)
- preparation for the after effects
- local community levels
- practice with drills
Impact Phase
- disaster strikes to
- goal is activating emergency response and reduce long-term
- First responders set up command post
- identify/remove victims and stabilize situations
What is the most important need for the impact phase?
protection for the first responders
- nurses help them
Postimpact Phase
begin 2 hours after or longer (years) to recover
- recovery
- rehabilitation
- rebuilding
*scam artists will appear**
evaluation
What is the longest disaster phase?
postimpact
What takes priority over rescue efforts?
protecting lives and health of first responders
- PPE
After exposure to any type of chemical, biological, or radioactive agent, personnel must go through
decontamination procedure
Vital step after postimpact phase
evaluation of prep and rescue
Internal emergencies
inside the facility/hospital
- active shooter
- power lost
- fire inside
- gas leak
If a tree falls inside the hospital and breaks the wall, is it an internal or external emergency?
internal (limb)
External emergencies
outside the facility
- fire
- flood
- bad storm
- tornado is wide to hit both hospitals = ancillary facilities
Short-term responsibilities for a disaster nurse
- Performs triage at the scene or in the emergency department.
- Provides emergency medical assistance at the scene or in the emergency department. Special attention is given to vulnerable groups, such as people with disabilities, children, and elderly persons.
- Provides assistance in the mobilization of necessary resources such as food, shelter, medication, and water.
- Works in collaboration with existing disaster organizations and uses available resources.
Long-term responsibilities for a disaster nurse
- Provides assistance with resettlement programs and psychological, economic, and legal needs.
- Partners with independent, objective media; local and national branches of government; international agencies; and nongovernmental organizations.
- Warns clients to be aware that many scam artists are present after any disaster and advises clients of factors to consider in detecting a scam.
What does a nurse need to keep in mind when providing disaster responses (and all the time)?
Nurse Practice Act
- what is within the scope of practice
In a disaster, nurses are able to function
outside their usual practice settings
- assume other roles (assist paramedics, direct traffic)
- under stressful and dangerous conditions
MCI
Mass casualty incident
MCI usually involve large numbers of injured >
1000
Casualty means
injured
dying
dead
MCIs **always require
assistance from people/resources outside community**
Triage of casualties differs from usual ED triage and is conducted in
<15 secs
Green tag
Walky talky
- require minimal or no treatment to save life or limb
Yellow tag
Nonurgent
- need treatment but not immediately and do not meet red criteria
Red tag require what criteria
require help breathing or assistance with their airways or whose respiratory rate is greater than 30 breaths per minute
breathing but have no pulse at the wrist (radial pulse)
- victims who are unable to respond to commands
Red tags need to be tx
immediately
- go to OR/ICU now
Re tags require the use of
large quantities of already scarce resources
Black tag
severely injured with no chance of survival - expected to die (fatality)
What can nurses do for black tags?
allow the family to say goodbye and pain meds for comfort
Black and green tags will only receive what type of care in a disaster
palliative
What tag?
sucking chest wound
red
What tag?
60% 3rd degree burns
black
What tag?
Distended abdomen
yellow
Total number of casualties a hospital can expect is estimated by
doubling number of casualties that arrive in first hour
Put these disaster injuries in order of who is seen first
scalp laceration walking
Scared and crying
Broken arm only
Pt killed
Sucking chest wound
Sucking chest wound 1
scalp laceration walking 2
Scared and crying (panic everyone else) 3
Broken arm only 4
Pt killed – 5
Variola major –
Smallpox (call employee health and get vaccines – Variola and varicella
If you have a pt with smallpox, what needs to be done?
call employee health and get vaccines – Variola and varicella
Bacillus anthracis –
Anthrax – tx with ciprofloxacin
Anthrax is treated with
ciprofloxacin
Yersinia pestis
- Plague
Clostridium botulinum
botulinum toxins) - Botulism
Francisella tularensis -
Tularemia
Filoviruses and arenaviruses
(Ebola and Lassa viruses) - Viral hemorrhagic fevers
Sarin Gas targets
nerve
Sarin gas tx
atropine and twopam
Phosgene affects the
pulmonary
Phosgene is made by
chemical manufacturing
Hydrogen cyanide targets
blood
Mustard gas targets
blister/vesicants
Antidotes for nerve agents are
atropine and twopam
Strategic National Stockpile is
national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items.
SNS can be landed within
24 hours
What should you know about the medicines in the SNS?
The medicine in the SNS is FREE for everyone.
The SNS has stockpiled enough medicine to protect people in several large cities at the same time
Main danger of RDDs
explosion
The 2nd most dangerous part of RDDs is
ionizing radiation
Ionizing radiation
Exposure may or may not include skin contamination with radioactive material
RDDS follow
predictable pattern from hot to cold zones
What is the 1st step for a pt from an RDD
DECONTAMINATION
Decontamination is
soap and warm water
pat dry
If a person comes up to you after a RDD explosion, what should you do
they and you need to be decontaminated and move away from the hospital
Decontamination is only 2nd to
ALS???????
Decontamination is used to
The physical removal of toxic agents
Prevent secondary exposure
Increase chances for survival
Soon as possible
Immediate decontamination
Removing all contaminated clothes and jewelry from the victim and washing the unclothed body thoroughly with warm water and soap.
*Avoiding the use of very hot water and vigorous scrubbing because these may actually force more of the chemical into the skin.
*Decontaminating all victims who have been exposed, even if it is unknown whether the agent was a vapor or liquid. Vapor exposure alone may not require decontamination; however, some vapors cling to clothing and skin and can be inhaled from these surfaces.
*Decontaminating victims as close as possible to the site of exposure. This minimizes the time of exposure and prevents moving the hot zone to another area.
Explosive devices cause damage to
lungs, middle ear, gastrointestinal tract (HOLLOW ORGANS)
Brain, Heart and Circulatory system,
Traumatic amputation, fractures, crush injuries
Can you ever tag someone down if you have assessed them again?
no only up
What should you do if you receive a bomb threat?
When you receive that call
- write down exact words
- caller id
Ask questions
Listen for background sounds
The callers voice
Remain calm
Extend the call as long as possible
Follow your department’s evacuation procedures.
After the bomb threat call has ended, do
immediately call IUPD on a landline to relay information
DO NOT do after receiving a bomb threat
Do a quick visual inspection of your area. Do not touch or move suspicious objects.
Do not use radios, pagers, or cell phones as they can trigger an explosive device. Only a landline until found
Ask the bomb threat caller
When will the bomb explode?
Where is the bomb?
What does it look like?
What will cause it to explode?
What building is it in?
What floor is it on?
What is your name and address?
Did you place the bomb? Why?
Do not hang up, extend the call as long as possible, listen to the callers voice do you hear a stutter, an accent, nervous speech impediment?
CERTs
community emergency response teams
- Life-saving skills with emphasis on decision making and rescuer safety
fire safety, light search and rescue, team organization, and disaster medical operations
NDMS
National Disaster Medical Systems
-Organizes and trains volunteer disaster medical assistance teams (DMATs)
- categorized according to ability to move
CISM
comprehensive, integrative, multicomponent crisis intervention system
- multiple crisis
- pre to post
CISM does what
Arranges group discussions to allow participants to verbalize and validate their feelings and emotions about the experience
Debrief relief to keep people working
All Hazard Approach
emergency preparedness planning that focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters, including internal emergencies and a man-made emergency (or both) or natural disaster
Incident Command
activate disaster plan and assign plans
Surge Capacity
total number of people able to have in a hospital (unlimited in disaster)
- reverse triage by discharging people who are not as serious in need of a bed or has had nothing invasive within 24-48 hours
Lockdown Plan
only 1 entrance and 1 exit
- too decrease overwhelming and safety reasons
Staffing Plan
call down list
Hospitals are expected to be able to maintain functionality for up to ____________ without external resources, but to remain functional in the face of extreme demand, hospital systems must increase available resources or find ways to redistribute resources in more efficient ways
96 hours
According to the expert panel, a patient is considered a candidate for early discharge if there is not
not a significant risk for a consequential medical event, including irreversible impairment, unexpected death, or a reduction in function within 72 hours of hospital discharge.
On the test, what do you need to keep in mind when delegating surge reverse triage tasks?
- Student with someone or only the student what can they be delegated to do
What is the 1st rule of disaster management?
The staff must feel safe and their families are safe so that they will and can work. Arrangements must be made for a place to rest or have a meal, and a place for families to be close and present.
What are the main topics now on disasters?
Intruder Safety
Active Shooter
Disaster scam artists
Anthrax s/s
fever
chills
chest discomfort
SOB, cough, confusion
dizziness
N/V/abd. pain
HA
drenching sweats
extreme fatigue/malaise
Anthrax survival rate with tx
55%
Anthrax is developed from
sheep
Anthrax PPE
N95
Gown
Gloves
(full protection)
Anthrax Tx
PCN
doxycycline
**Ciprofloxacin
- 60 days due to spores germination
Botulism s/s
diplopia, drooping eyelids
difficulty swallowing
dry mouth and altered voice
**descending flaccid paralysis in proximal to distal pattern
abd pain, N/V/D, respiratory muscle paralysis
Organophosphate is the
Poison
Organophosphate is the
Poison
Atropine does what
Speeds up the heart rate to absorb and excrete more of the poison
Botulism PPE
Standard precautions
Those with flaccid paralysis should be on droplet precautions until meningitis is ruled out
Botulism Tx
Botulism antitoxin
Monitoring and support of respiratory function
Brucellosis risk
from unpasteurized dairy products, those who work in slaughterhouses, meat packing, veterinarians
Brucellosis s/s
Fever, sweats, malaise, anorexia, headache, muscle/joint/back pain, fatigue
Survival rate 98% with treatment
Brucellosis chronic s/s
Chronic: recurrent fevers, arthritis, swelling of male genitalia, endocarditis, lingering neurological symptoms, depression, hepatomegaly, splenomegaly
Brucellosis PPE
Standard precautions
Standard disinfectants
Brucellosis Tx
Doxycycline, rifampin—in combination for 6-8 weeks
Cholera generic name
(vibrio cholerae)
Cholera s/s
Profuse watery diarrhea, vomiting, tachycardia, dry mucous membranes, loss of skin elasticity, hypotension, thirst, muscle cramps, restlessness or irritability, acute renal failure, severe electrolyte imbalance, coma.
Cholera PPE
Standard precautions
Strict handwashing
Clorine solutions for disinfection
Cholera Tx
Rehydration-oral or IV
Antibiotic treatment-doxycycline, azithromycin for children and pregnant women
Zinc treatment
Q fever genetic name
(Coxiella burnetii)
Q fever s/s
High fever (104-105), severe headache, general malaise, myalgia, chills/sweats, dry cough, N/V/D, abdominal pain, chest pain
Chronic: endocarditis reported in 60-70% of cases
Survival rate 98% with treatment
Highest risk: pregnant women, immunosuppressed individuals, those with pre-existing heart valve defects
Q fever PPE
Standard precautions
Q fever Tx
Antibiotics-doxycycline or other tetracyclines
Q fever risk from
Worldwide disease
Cattle, sheep and goats are primary reservoir
Hardy, resistant to heat
Infection is usually inhalation-barnyard dust
Tick bites, ingestion of unpasteurized milk, human to human—rare
Q fever chronic s/s
Chronic: endocarditis reported in 60-70% of cases
Q fever highest risk
: pregnant women, immunosuppressed individuals, those with pre-existing heart valve defects
Hemorrhagic fever is also known as
Ebola
Lassa
Marburg
Ebola s/s
Fever, severe headache, myalgia, malaise, fatigue, weakness, N/V/D, abdominal pain, unexplained hemorrhage
Ebola avg incubation
8-10 days
Ebola chronic s/s
joint, vision problems
Virus antibodies remain present for possibly 10 years
Ebola remains for
Virus remains present in bodily fluids, including semen, for 3-9 months
Ebola PPE
Impermeable gown or coverall, single-use
PAPR or N95 mask, full-face covering and head-shroud
Single-use exam gloves with extended cuff, 2 pair
Single-use boot covers that extend to at least mid-calf
Single-use apron that covers the torso to the level of mid-calf
Ebola Tx
Tx s/s
Rehydration
Oxygen
Experimental vaccines and treatments pending
Antibiotics if secondary infections occur
Lassa fever is what type of virus
(Viral illness occurs in west Africa, animal-borne)
Lassa fever s/s
Low-grade fever, general malaise, weakness, headache. In 20% of individuals disease may progress to serious symptoms such as hemorrhage (gums, eyes, nose), respiratory distress, vomiting, facial swelling, pain in chest/back/abdomen, hearing loss, tremors, encephalitis
Lassa fever PPE
Mask with face shield or goggles
Impervious gown
Gloves
Lassa fever Tx
Ribavirin (antiviral drug)
Rehydration
Electrolyte balance
Oxygenation
Antibiotics for secondary infections
Marburg virus is what
Viral hemorrhagic fever, affects humans and primates, in filovirus family with Ebola, reservoir host is the African fruit bat)
Marburg virus s/s
Fever, chills, headache, myalgia, maculopapular rash (trunk), N/V/D, chest pain, sore threat, abdominal pain, jaundice, pancreatitis, severe weight loss, delirium, shock, liver failure, hemorrhage, multiorgan disfunction
Case-fatality rate 23-90% depending on strain
Marburg virus PPE
Strict isolation
Gloves, gown, masks
Proper disposal of waste
Marburg virus Tx
No specific treatment, supportive
Rehydration
Electrolyte stabilization
Maintaining oxygen status
Replacing lost blood/clotting factors
Antibiotics for secondary infections
Experimental treatments pending
Plague generic name
Yersinia pestis; bacterial; occurs in western US, Africa, Asia)
Bubonic Plague s/s
fever, headache, chills, weakness, 1+ swollen/tender/painful lymph nodes (buboes). Spread by bite from infected flea.
50% fatality without treatment
Pneumonic Plague s/s
fever, headache, weakness, rapidly developing pneumonia with shortness of breath, chest pain, cough, bloody/watery mucous. Spread person to person by infected droplets.
Bubonic Plague PPE
Standard precautions
Pneumonic Plague PPE
Droplet precautions
Plague Tx
Gentamicin, fluoroquinolones are first-line treatments, duration 10-14 days
Ricin toxin is found in
Poison found naturally in castor beans
Forms: powder, mist, pellet, dissolved in water
Prevents cells from making the proteins they need
Ricin toxin does what
Prevents cells from making the proteins they need
Ricin toxin s/s
inhalation
: respiratory distress, fever, cough, nausea, chest discomfort, cyanosis, pulmonary edema, hypotension
Ricin toxin s/s
ingestion
vomiting/diarrhea, eventually bloody; seizures, hypotension, blood in urine, organ failure
Ricin toxin PPE
Contaminated patients: Powered air-purifying respirator (PAPR)
Full face/eye protection
Chemical resistant clothing
Gloves
Decontaminated pts: Standard precautions
Ricin toxin Tx
Supportive care
Respiratory support/oxygen
Rehydration measures
Electrolyte stabilization
Anticonvulsants
Vasoconstrictors
Activated charcoal for recent ingestion
Smallpox s/s initial
Incubation: 12-14 days
Initial symptoms: fever, malaise, head/body aches, vomiting.
Early Rash: small red spots on tongue and in mouth. When sores break open and emit drainage, patient is most contagious
Rash appears on skin as lesions in mouth break open, starts on face, spreads to arms and legs, then to hands and feet. Fever drops and patient feels better.
Day 3 of rash: lesions become popular
Day 4: lesions drain thick, opaque drainage, has trademark depression in center of lesion; fever rises again at this time and remains elevated until lesions develop scabs
Pustular rash: sharply raised, round/firm to the touch, feel like BB pellet
Scabs form
Scabs fall off, pitted scars remain, patient is contagious until ALL scabs have fallen off.
Overall fatality rate of 30%
Smallpox
(variola virus, human hosts only)
Smallpox PPE
N95 mask
Airborne and contact isolation precautions
Smallpox Tx
Antivirals
Antipyretics
Hydration
Smallpox pt comes in what should the nurse do?
call CDC for variola vaccines for the entire staff
Smallpox eradicated?
no
Tularemia is
(bacterial, Francisella tularensis, spread by rabbits/hares/rodents, contact with infected animal, tick and deer fly bites)
Tularemia s/s
Ulceroglandular: skin ulceration with regional lymph node involvement
Gladular: without ulcer
Oculoglandular: eye infection (mucous membrane transmission, irritation and inflammation of eye and preauricular lymph node)
Oropharyngeal: spread by contaminated food/water, symptoms include sore throat, oral ulcers, tonsillitis, swelling of lymph nodes in neck
Pneumonic (most serious): contracted through dusts/aerosols containing the organism. Symptoms include cough, chest pain, difficulty breathing
Typhoidal: any combination of the general symptoms without the localized symptoms of the other syndromes.
Tularemia PPE
Standard precautions
Tularemia Tx
Streptomycin
Gentamicin
Tetracyclines may be used as an alternative
Cipro/other fluoroquinolones are not FDA approved but have shown good efficacy in trials
Typhoid fever generic name
(bacterial, Salmonella typhi)
Typhoid fever s/s
Sustained high fever (103-104), fatigue, malaise, myalgia, abdominal pain, headache, anorexia, macular rash (rose-colored), mild vomiting, diarrhea
Chronic carrier state (excretion of the organism for more than a year) occurs in 5% of infected persons
20% of patients die from complications of the infection
Typhoid fever PPE
Contact precautions
Typhoid fever Tx
Antibiotics: fluoroquinolones, ceftriaxone, azithromycin
Eastern equine encephalitis spread by
(Viral, spread by mosquitos)
Eastern equine encephalitis PPE
Droplet precautions prior to identification of agent
Standard precautions once EEEV has been definitively diagnosed
Eastern equine encephalitis s/s
Headache, high fever, chills, vomiting, disorientation, seizures, coma
33% mortality, significant brain damage in most survivors
Eastern equine encephalitis Tx
Supportive care
Fluids
Anticonvulsants
Possibly antivirals
Corticosteroids (trials)
Ammonia agent
Pulmonary/choking agent
Ammonia s/s
Majority of cases are inhalation, lead to symptoms of ocular, nasal, and respiratory irritation, lacrimation, cough, suffocation, choking sensation, dyspnea
May cause burns to oral/nasal/pharyngeal mucosa, bronchiolar/alveolar edema, and airway destruction
Low airborne concentrations produce irritation to eyes and nose
Ingestion: N/V/abdominal pain, severe esophageal burns, corrosive injury to mouth/throat /stomach
Ammonia PPE
Inhalation: standard precautions
Skin/clothing contamination: contact precautions, well-ventilated room
Ammonia Tx
Irrigation of eyes
Airway support
Administer oxygen
If bronchospasm occurs, administer bronchodilators
Racemic epinephrine for stridor
Ammonia do not give
Do NOT give activated charcoal or induce emesis. Give 4-8 oz of water or milk if the patient is able to swallow.
Arsenic agent
blood
Arsenic s/s
Garlic odor on breath, vomiting, abdominal pain, bloody diarrhea—eventual dehydration and shock, dysrhythmias (prolonged QT, Twave changes), fever, facial edema, altered mental status, multisystem organ failure that eventually leads to death,
Mee’s lines in fingernails, peripheral neuropathy with no known cause, irritation of mucosa in pharynx, larynx, and bronchi; pulmonary edema; tracheobronchitis; bronchial pneumonia; nasal septum perforation
Arsenic PPE
Standard precautions
Arsenic Tx
Hemodynamic stabilization
Gut decontamination
Hydration
Ingestion: gastric lavage
Hemodialysis for severe acute renal failure
Chelating agents
Bromine agent
Bromine (CA)
Pulmonary/choking agent
(naturally occurring element, brownish red with musty/fruity odor)
Bromine gas is heavy so settles in low-lying areas
Bromine odor
(naturally occurring element, brownish red with musty/fruity odor)
Bromine s/s
Inhalation: cough, difficulty breathing headache, irritation of mucous membranes, dizziness, lacrimation
Ingestion: N/V/D, abdominal pain, hemorrhagic gastroenteritis
Bromine PPE
Standard unless clothing is contaminated, then contact
Contact
Bromine Tx
Supportive
Hydration
Oxygen
Treatment of burns
Dimercaprol or MucoMyst may be indicated
Bromine found in
settles in low-lying areas
Carbon monoxide agent
Blood agent
(Colorless, odorless)
Carbon monoxide s/s
Shortness of breath, hypoxia, angina, seizures, respiratory depression, coma, delayed neurological sequelae
Carbon monoxide PPE
Standard precautions
Carbon monoxide Tx
Supportive care
Hyperbaric oxygen chamber
Chlorine agent
Pulmonary/choking agent
(Pungent, irritating odor-similar to bleach; gas is yellow/green in color)
Chlorine smell
Pulmonary/choking agent
(Pungent, irritating odor-similar to bleach; gas is yellow/green in color)
Chlorine s/s
Blurred vision, pain/erythema/blisters if dermal exposure, burning in eyes/nose/throat, cough, chest tightness, pulmonary edema, N/V, lacrimation, bronchospasm
Chlorine PPE
Standard precautions unless clothes are saturated
Chlorine Tx
Removal of agent
Supportive care
Bronchodilators
Oxygen
Intubation, if necessary
Chloroacetophenone
Riot control agents
(Colorless or gray, apple blossoms odor)
Chloroacetophenone s/s
Burning in eyes/nose/throat, cough, sore throat, nausea, shortness of breath, rhinorrhea, chest tightness, wheezing, metallic taste
Chloroacetophenone PPE
For decontamination: SCBA mask, TECP suit, chemical resistant outer and inner gloves, chemical resistant boots with steel toe
After decontamination: standard precautions
Chloroacetophenone Tx
Supportive care
Airway support
Oxygen, if necessary
Intubation, if necessary
Symptom control: antiemetics, bronchodilators, fluids
Phosgene oxime
Vesicating/blister agent
(urticant or nettle agent, colorless when solid and yellowish/brown when liquid)
-organophosphate from chemical manifestations
Phosgene oxime s/s
Inhaled: irritation to upper respiratory tract, rhinorrhea, hoarseness, sinus pain, pulmonary edema, cough, shortness of breath
Skin: Intense itching similar to hives, causes corrosive damage to skin, blanching of skin surrounded by red rings within 30 seconds of exposure, whitened areas become necrotic after
Eyes: severe pain, irritation, lacrimation, temporary blindness
Phosgene oxime PPE
For decontamination: SCBA mask, TECP suit, chemical resistant outer and inner gloves, chemical resistant boots with steel toe
After decontamination: standard precautions
Phosgene oxime Tx
Removal of agent
Supportive care
Washing the body
Eye irrigation
Symptom management for respiratory issues
Anticonvulsants
Hydration
Hydrogen chloride
Pulmonary/choking agent
(Colorless to slightly yellow with pungent odor at room temp)
Hydrogen chloride odor
Pulmonary/choking agent
(Colorless to slightly yellow with pungent odor at room temp)
Hydrogen chloride s/s
Inhalation: cough, burning to nose/throat, shortness of breath, laryngedema, respiratory arrest, Reactive Airway Dysfunction Syndrome
Ingestion: Abdominal pain, dysphagia, N/V, corrosive injuries to upper GI tract
Hydrogen chloride PPE
Standard Precautions unless clothes/skin are saturated, then SCBA with chemical protective clothing
Hydrogen chloride Tx
Inhalation: supportive, give oxygen, may consider racemic epi, bronchodilators, intubation if necessary
Ingestion: do NOT induce vomiting, give 4-8 ounces of water or milk
Mustard Gas agent
Vesicating/blister agent
(Smells like garlic, onions, or mustard; can be odorless)
Mustard Gas s/s
Inhalation: rhinorrhea, sneezing, laryngitis, sinus pain, epistaxis, shortness of breath, cough, ocular irritation/pain/lacrimation, photosensitivity, respiratory arrest
Ingestion: abdominal pain, diarrhea, fever, nausea, vomiting
Mustard Gas PPE
Standard precautions
For decontamination, utilize SCBA with chemical protective clothing
Mustard Gas Tx
Supportive
Eye irrigation
Wash skin
Monitor respiratory status
Bronchodilators
Oxygen
For ingestion, orogastric lavage may remove some of the chemical—be aware of the risk for bleeding and perforation. Do not give activated charcoal.
Osmium tetroxide agent
Pulmonary/choking agent
(Colorless to pale yellow, pungent odor)
Osmium tetroxide odor
Pulmonary/choking agent
(Colorless to pale yellow, pungent odor)
Osmium tetroxide s/s
Inhalation: burning sensation, cough, headache, wheezing, shortness of breath, visual disturbances
Ingestion: Burning sensation, abdominal cramps, shock or collapse
Skin/eyes: redness, burning, blurred vision, severe deep burns, blisters, lacrimation
Osmium tetroxide PPE
Standard precautions
For decontamination, use SCBA
Osmium tetroxide Tx
Supportive
Eye irrigation
Wash skin
Monitor respiratory status
Bronchodilators
Oxygen
Lewisite agent
Lewisite
Vesicating/blister agent
Contains arsenic
(Smells like geraniums)
Lewisite contains
Contains arsenic
(Smells like geraniums)
Lewisite smells like
Contains arsenic
(Smells like geraniums)
Lewisite s/s
Inhalation: onset rapid; cough, dyspnea, pneumonitis, acute lung injury
Ingestion: onset 15-20 min; vomiting, hypotension, shock
Skin/eye: onset 15-20 min; erythema, blistering, lacrimation, pain,
Lewisite PPE
Decontamination occurs outside the ED
For decontamination:
Pressure-demand, self-contained breathing apparatus
PPE
Butyl rubber chemical protective gloves
Lewisite Tx
Supportive
Inhalation: protect airway
Oxygenation
Intubation
Maintain circulation
Bronchodilators
Ingestion: do NOT induce emesis
Sodium Monofluoroacetate agent and route
blood
ingestion
Soman and Sarin Gas agent
nerve
Soman and Sarin Gas odor
(clear, colorless, tasteless liquid with a slight odor-mothballs or rotten fruit, potent acetylcholinesterase inhibitor )
Soman and Sarin Gas s/s
slobber
loss of bodily functions
diarrhea
Inhalation or ingestion: hypo/hypertension, blurred vision, chest tightness, confusion, cough, diarrhea, increased oral secretions, diaphoresis, headache, increase urinary output, N/V/abd pain, tachypnea, rhinorrhea, brady/tachycardia, pinpoint pupils, lacrimation, weakness, convulsions, loss of consciousness, paralysis, respiratory failure
Soman and Sarin Gas PPE
Decontamination occurs outside the ED for liquid exposure/none required for vapor exposure
For decontamination:
Pressure-demand, self-contained breathing apparatus
PPE
Butyl rubber chemical protective gloves
Soman and Sarin Gas Tx
Supportive
Oxygen
IV Access
Intubation with severe toxicity
Suction ready
Atropine after oxygenation and ventilation
(Atropine and pralidoxime are antidotes to nerve agents)
Do NOT induce vomiting or give fluids to drink
VX agent
nerve
VX odor
clear, amber-colored, odorless, oily liquid; least volatile nerve agent; potent acetylcholinesterase inhibitor)
VX s/s
Inhalation, ingestion, or skin/eye contact: rhinorrhea and tightness in throat and chest, pinpoint pupils, shortness of breath, excessive salivation, diaphoresis, N/V/abd pain, involuntary defecation and urination, muscle twitching, confusion, seizures, flaccid paralysis, coma, respiratory failure, and death
VX PPE
Decontamination occurs outside the ED
For decontamination:
Pressure-demand, self-contained breathing apparatus
PPE
Butyl rubber chemical protective gloves
VX Tx
Supportive
Oxygen
IV Access
Intubation with severe toxicity
Suction ready
Atropine after oxygenation and ventilation
(Atropine and pralidoxime are antidotes to nerve agents)
Do NOT induce vomiting or give fluids to drink
