Biomedical Engineering Reference
In-Depth Information
of mustard that appeared sluggish, apathetic, and
lethargic. These reports suggest that minor psycho-
logical problems could linger for a year or longer.
available ophthalmic solutions after the eyes are
thoroughly irrigated. Regular application of homa-
tropine (or other anticholinergic drug) ophthalmic
ointment will reduce or prevent future synechiae
formation. A topical antibiotic applied several
times a day will reduce the incidence and severity
of infection. Vaseline or a similar substance should
be applied to the edges of the lids regularly to
prevent them from sticking together. This permits
drainage of any underlying infection and prevents
adhesions and scarring during healing. Topical
analgesics may be useful initially if blepharospasm
is too severe to permit an adequate examination,
but topical analgesics should otherwise be avoided
and systemic analgesics should be given for eye
pain. Topical steroids are not of proven value, but
their use during the first day or two might reduce
inflammation. Sunglasses may reduce discomfort
from photophobia. For suspected severe expo-
sure early consultation with an ophthalmologist is
prudent [24].
6.4.4.6 Bone marrow
Significant exposure to mustard will cause damage
to precursor cells in the bone marrow causing
pancytopenia and immunosuppression similar to
chemotherapy or radiation treatment patients.
Severity of blisters does not predict marrow
involvement as 90% of mustard passes through the
skin and is absorbed systemically.
6.4.4.7 Death
Most casualties die of massive pulmonary damage
complicated by infection, bronchopneumonia, and
sepsis from immune suppression. When exposure
is not by inhalation, the mechanism of death is less
clear. In studies with animals in which mustard was
administered via routes other than inhalational, the
animals died from 3 to 7 days after the exposure;
they had no signs of pulmonary damage and often
had no signs of sepsis. The mechanism of death
was not clear, but autopsy findings resembled those
seen after radiation. Mustard is considered to be
a radiomimetic because it causes tissue damage
similar to that seen after radiation.
6.4.5.2 Skin
Treatment priorities are keeping the patient
comfortable, the skin lesion clean and preventing
infection. Erythema can be treated with calamine
or other soothing lotion or cream (e.g., 0.25%
camphor and menthol) to reduce burning and
itching. Small blisters (under 1-2 cm) should be
left intact. Because larger ones will eventually
break they should be carefully unroofed. Denuded
areas should be irrigated 3-4 times daily with
saline, other sterile solution, or soapy water. Modi-
fied Dakins solution (sodium hypochlorite) was
used in World War I and in Iranian casualties
for irrigation and as an antiseptic. After irriga-
tion the open blisters are liberally covered with
a topical antibiotic such as silver sulfadiazine
or mafenide acetate to a thickness of 1-2mm.
If an antibiotic cream is not available, sterile
petrolatum will be useful. Multiple or large areas
of blistering suggest the need for hospitalization
and whirlpool bath irrigation. Systemic analgesics
should be used liberally, particularly before manip-
ulation of the patient or irrigation of the burn
6.4.5 Medical Management
The management of a patient exposed to mustard
may be simple, as in the provision of symptomatic
care for a sunburn-like erythema, or extremely
complex, as providing total management for a
severely ill patient with burns, immunosuppres-
sion, and multi-system involvement. Suggested
therapeutic measures for each organ system are
provided below. Guidelines for general patient care
are not intended to take the place of sound clin-
ical judgment, especially in the management of
complicated cases [19,21].
6.4.5.1 Eyes
Preventing infection and scarring is the treatment
goal for mustard injury of the eyes. Conjunc-
tival irritation will respond to any of a number of
