CBRNE - Vesicants, Organic Arsenicals - L, ED, MD, PD, HL Workup

  • Author: Geoffrey M Fitzgerald, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 3, 2011
 

Laboratory Studies

  • The US military and the North Atlantic Treaty Organization (NATO) have developed several field tests to detect various CW agents. The field tests that reliably detect L and the other organic arsenicals include the M256A1, individual chemical agent detector (ICAD), miniature chemical agent monitor (MINICAMS), M18A2, M21, M90, M93A1 Fox, chemical agent monitor (CAM), and depot area air monitoring system (DAAMS). Less sophisticated means of detection are M8 detection paper (turns red with lewisite [L]) and M9 paper (turns color when exposed to arsenicals).
  • With exception of urinary arsenic excretion, no specific tests exist for organic arsenical exposure. Leukocytosis and other nonspecific markers of tissue destruction may appear.
  • Culture damaged skin routinely to stave off opportunistic skin infections.
  • Also perform sputum Gram stain and culture if the respiratory system is affected.
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Imaging Studies

  • Pneumonia commonly follows pulmonary damage in 3-5 days. Obtain a chest x-ray as indicated.
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Procedures

  • Massive tissue damage to the respiratory mucosa can cause acute airway compromise from laryngospasm and/or necrotic debris. Emergent endotracheal intubation may be required. Obtain a bronchoscopy consultation if pseudomembrane formation is suggested.
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Contributor Information and Disclosures
Author

Geoffrey M Fitzgerald, MD  Consulting Staff, Concord Emergency Medical Associates

Disclosure: Nothing to disclose.

Coauthor(s)

Timothy Vollmer, MD  Consulting Staff, Department of Emergency Medicine, Geisinger Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Fred Henretig, MD  Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References
  1. Devereaux A, Amundson DE, Parrish JS. Vesicants and nerve agents in chemical warfare. Decontamination and treatment strategies for a changed world. Postgrad Med. Oct 2002;112(4):90-6; quiz 4. [Medline].

  2. Comptom JA. The arsenicals. In: Military Chemical and Biological Agents: Chemical and Toxicological Properties. 1987:17-43.

  3. Ford MD. Metal and metalloids. In: Emergency Medicine: A Comprehensive Study Guide. 5th ed. 2000:1185-1191.

  4. Ford MD. Arsenic. In: Goldfrank's Toxicology Emergencies. 6th ed. 1998:1261-1270.

  5. Karalliedde L, Wheeler H, Maclehose R, Murray V. Possible immediate and long-term health effects following exposure to chemical warfare agents. Public Health. Jul 2000;114(4):238-48. [Medline].

  6. NATO. Blistering agents. In: Emergency War Surgery NATO Handbook. 2nd US revision. 1988:88-90.

  7. Sidell FR, Urbanetti JS, Smith WJ. Vesicants. In: Medical Aspects of Chemical and Biological Warfare. 1997:197-228.

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