1、Chemical/Radiological PrinciplesCHEMICAL TERRORISMChemical/Radiological PrinciplesOBJECTIVES Learn how to perform a rapid assessment of a nerve agent terrorism situation.Recognize characteristic signs and symptoms of nerve agent poisoning.Chemical/Radiological PrinciplesOBJECTIVES Understand proper
2、decontamination for nerve agent poisoning.Learn medical management of nerve agent exposed victims.Learn specific antidotes for nerve agent poisoning victims.Chemical/Radiological Principles An unknown gas is released in the downtown rapid transit station.It is described as a thick mist,and was found
3、 in 5 separate stops.Thousands of commuters rapidly fled the stations to the streets.EMS transport is overwhelmed,and several local EDs are unable to absorb the patients presenting by ambulance,car,taxi,and on foot.Many patients present to offices and local health departments.ScenarioFriday,January
4、31 8:47 AM(Rush Hour)Chemical/Radiological Principles One patient that presents to a local health clinic complains of tearing and runny nose.He also has mild shortness of breath.Mild wheeze is noted on exam.Ten other patients at the clinicare asymptomatic,but are very worried.ScenarioFriday,January
5、31 10:02 AMChemical/Radiological Principles Public health officials confirm that the gas was Sarin,similar to the toxin used in the subway of Tokyo.ScenarioFriday,January 31 10:27 AMChemical/Radiological Principles Has your staff been adequately trained about chemical weapons?Does your staff underst
6、and basic principles of decontamination?Who should your staff alert?Who will alert your staff in the event of a chemical terrorism event?Things to ConsiderChemical/Radiological PrinciplesNerve AgentsChemical/Radiological Principles Liquids that disseminate in the vapor/aerosolized form Onset is abru
7、pt(seconds to hours)Designed to irritate,incapacitate,injure or kill Predominantly inhalational and dermal threats If death occurs,usually respiratory causeCharacteristics of Nerve AgentsChemical/Radiological Principles Chemical incidents are obvious shortly after exposure.Biological agents will tak
8、e days to cause symptoms.ONE patient can contaminate your facility First responders/health care providers are in the line of fireCharacteristics of Nerve AgentsChemical/Radiological Principles First used as a weapon during WWI Most recent event-Japanese subway incident in 2019 Aum Shinrikyo cult rel
9、eased Sarin into 5 subway cars in downtown Tokyo 12 deaths,hundreds injured,5500 sought care 4,600 self-referred 135 first responders were injuredHistory of Nerve Agent Weapons UseChemical/Radiological PrinciplesShoko AsaharaChemical/Radiological PrinciplesNERVE AGENTSChemical/Radiological Principle
10、s Military Tabun(GA),Sarin(GB),Soman(GD),VX Commercial Parathion,Sevin Therapeutic Drugs Antilirium Prostigmine Mestinon General CharacteristicsChemical/Radiological Principles Effects of vapor-immediate Wide range of symptoms-Affects sensitive organs of the face and respiratory system-Over-stimulat
11、ion of the central nervous systemGeneral CharacteristicsChemical/Radiological PrinciplesNormal Nerve FunctionChemical/Radiological PrinciplesNormal Nerve FunctionChemical/Radiological PrinciplesNerve Agent ActionChemical/Radiological PrinciplesSLUGBAM:Salivation Lacrimation Urination GI distress(Nau
12、sea,Vomiting,Diarrhea)Bronchorrhea(Bradycardia,Bronchospasm)Abdominal cramps MiosisSigns and SymptomsMuscarinic EffectsChemical/Radiological PrinciplesHow Bad Is This Stuff?VX LD50Chemical/Radiological PrinciplesSystemEffectSkeletal musclesTwitchingWeaknessFlaccidityCardiovascularHRBlood PressureCNS
13、LOC,SeizuresSigns and SymptomsNicotinic EffectsChemical/Radiological PrinciplesExposureSymptomVery small dropSweatingLocal twitchSmall dropNauseaVomitingDiarrheaDropLOCConvulsionsApneaFlaccid paralysisSigns and SymptomsDermal Exposure EffectsChemical/Radiological PrinciplesExposureSymptomSmall amoun
14、tMiosisSLUGBAMSOBChest tightnessLarge amountLOCConvulsionsParalysisDeathSigns and SymptomsVapor Exposure Effects3613204162Signs and SymptomsEffect on pupil at x number of daysChemical/Radiological Principles Clinical picture is key Erythrocyte acetylcholinesterase activity level-Amount of inhibition
15、 does not correlate with symptoms Various electronic and“paper”detectors are available-for HAZMAT useDiagnosisChemical/Radiological PrinciplesGENERAL PATIENT MANAGEMENTChemical/Radiological PrinciplesChemical/Radiological Principles PPE(mask,gloves and protective suit)Decontamination Dont let your s
16、etting become contaminated ABCs Communicate with public health officials Poison Control Center(800 222-1222)Antidotes where appropriateGeneral ManagementChemical/Radiological Principles Soap and Water Hypochlorite Solution 0.5%for skin 6 oz calcium hypochlorite in 5 gallons water 5.0%for equipment 4
17、8 oz calcium hypochlorite in 5 gallons waterPrehospital ManagementChemical/Radiological Principles Adult atropine dose:“enough”Give atropine regardless of heart rate Pediatric Considerations 0.01mg/kg Atropine used until endpoint achieved(resolution of secretions)TreatmentChemical/Radiological Princ
18、iples Atropine-Blocks the effects of neurotransmitter 2-PAMCl(Pralidoxime)-Removes nerve agent from the enzyme Military Autoinjector MARK IAntidoteAChE2-PAMClChemical/Radiological PrinciplesNameSynonymAging T1/2SarinGB 5 hoursSomanGD2 minTabunGA40 hoursVXNone40 hours“Aging”Chemical/Radiological Prin
19、ciplesNerve Agent QuestionsChemical/Radiological PrinciplesWhat was the public health lesson learned from the 2019 Sarin terrorists attack in the subway system of Tokyo,Japan?This bioterrorist attack could only occur in a large city with an enclosed underground subway system.The walking wounded and
20、hysterical patients often overload the medical system Religious cults should be placed under strict federal surveillanceAmple supplies of the antidotes are readily availableQuestion#1Chemical/Radiological PrinciplesIn the acute phase of poisoning,one of the consistent findings that differentiates Sa
21、rin poisoning from hysteria is:Cholinesterase enzyme blood levels Garlic smell on victims Pinpoint pupils Tachycardia Question#2Chemical/Radiological PrinciplesBased on past experience,which of the hospital supplies/equipment below is most likely to run out after a mass casualty exposure to Sarin gas?VentilatorsPersonal Protective Equipment Hemodialysis machinesAtropine Question#3Chemical/Radiological PrinciplesThis completes the current presentation.
