Biomedical Engineering Reference
In-Depth Information
areas. Systemic antipruritics such as trimeprazine
or benadryl may also provide some symptomatic
relief. While mustard injuries resemble thermal
burns they do not have the associated fluid require-
ments of thermal burns [22].
6.4.5.5 Bone marrow
Sterilization of the gut by non-absorbable antibi-
otics should be considered to reduce the possibility
of sepsis from enteric organisms. If the patient
is neutropenic all transfusion therapy should
be irradiated and CMV negative. In addition,
hematopoietic growth factors, granulocyte colony-
stimulating factors, and granulocyte-macrophage
colony-stimulating factor, are potent stimulators
of hematopoiesis and may shorten the duration
of neutropenia and thus reduce morbidity and
mortality. The role of bone marrow transplantation
is unclear.
6.4.5.3 Pulmonary
Upper airway symptoms such as a sore throat, non-
productive cough, and hoarseness; may respond to
steam inhalation and cough suppressants. Sterile
bronchitis or pneumonitis manifested by produc-
tive cough, dyspnea, fever, and leukocytosis often
occurs 12-24 hours after exposure. Infection often
occurs on or about the third day. Its pres-
ence is signaled by an increased fever, increased
pulmonary infiltrate by X-ray, and increased
sputum production and character. Appropriate
antibiotic therapy should be guided by positive
sputum Gram stain and culture. Intubation should
be performed early before laryngeal spasm or
edema makes it difficult or impossible. Intubation
permits better ventilation and facilitates suction of
the necrotic and inflammatory debris. Oxygen may
be needed, and early use of PEEP or CPAP may be
of benefit. If there is a suggestion of pseudomem-
brane formation, bronchoscopy should be done to
permit suctioning of the necrotic debris by direct
vision. Bronchodilators may be of benefit for bron-
chospasm. If they fail, steroids may be used. There
is little evidence that the routine use of steroids is
beneficial. The need for continuous use of assisted
or controlled ventilation suggests a poor prognosis.
Death often occurs between the fifth and tenth
day after exposure because of pulmonary insuf-
ficiency and infection complicated by immuno-
suppression from mustard induced bone marrow
damage [25].
6.4.5.6 Other
Sulfur donors such as sodium thiosulfate decreased
systemic effects and elevated the LD
50
when given
before exposure or within 20 minutes after expo-
sure in experimental animals. Activated charcoal
given orally to casualties was of no value.
References
1. J. Robinson.
The Rise of CB Weapons The Problem
of Chemical and Biological Warfare
, p. 71. New
York, NY, Humanities Press, 1971; 71.
2. J. H. Wills and I. A. DeArmon. A Statistical Study
of the Adamek Report Medical Laboratory Special
Report 54: Army Chemical Center, MD: Medical
Laboratories, 1954.
3. K. Wilson. Directorate of Medical Research, Edge-
wood Arsenal, Md, mid to late 1960's.
4. C. M. Gosden.
Chemical and biological weapons
threats to America: are we prepared?
Congressional
Hearings Intelligence and Security Committee, 1998.
5. H. Morita, N. Yanagisawa, T. Nakajima, et al.
Sarin poisoning in Matsumoto,
Japan.
Lancet
346:290-293, 1995.
6. Y. Asai and J. Arnold. Terrorism in Japan.
Prehos-
pital Disaster Med
18, 2003.
7. E. Broughton. The Bhopal disaster and its aftermath:
a review.
Environ Health
10:6-12, 2005.
8. H. Nozaki, S. Hori, Y. Shinozawa, et al.
Secondary exposure of medical staff to sarin
vapor in the emergency room.
Intensive Care Med
21:1032-1035, 1995.
6.4.5.4 Gastrointestinal
Antiemetics and anticholinergic drugs should
control early nausea and vomiting. Prolonged
vomiting or voluminous diarrhea beginning days
after exposure suggests severe systemic poisoning
which is a poor prognostic sign. Intravenous fluids
to maintain intravascular volume are indicated.
