Phosgene Oxime Exposure Follow-up
- Author: Erik D Schraga, MD; Chief Editor: Robert G Darling, MD, FACEP more...
Further Inpatient Care
- Pain associated with phosgene oxime (CX) exposure typically remains severe for several days. Consider admission for pain control. Admit any patients demonstrating significant respiratory symptoms for observation and supportive care.
Further Outpatient Care
- Patients may be treated on an outpatient basis once respiratory symptoms have resolved and nonparenteral analgesics are adequate for pain control.
- Instruct the patient on appropriate wound care techniques and provide close follow-up care to the patient to ensure adequate healing.
- Ophthalmology follow-up care to ensure resolution of ocular injuries also is important.
Inpatient & Outpatient Medications
- Inpatient medications include parenteral analgesics (eg, morphine, meperidine), broad-spectrum ophthalmic antibiotic ointments for eye injuries, and broad-spectrum skin antibiotic ointments for skin burns.
- Outpatient medications include oral analgesics (eg, codeine, oxycodone) if continued pain management is required after discharge and continued antibiotic ointments for eye and skin injuries until full healing has occurred.
Transfer
- Transfer to a higher medical center may be required for severe pulmonary CX injuries if the initial hospital is unable to provide the necessary intensive care support. Secure the airway and initiate ventilatory support prior to transfer.
Complications
- Potential complications include scarring, wound infections, loss of vision, and death from severe respiratory injury.
Prognosis
- Prognosis is generally good for minimal exposures. Severe and early respiratory distress portends a poor prognosis.
Patient Education
- Educate outpatients about the signs and symptoms of wound infection for which they immediately should seek further medical care.
- For excellent patient education resources, visit eMedicine's Bioterrorism and Warfare Center. Also, see eMedicine's patient education articles Chemical Warfare and Personal Protective Equipment.[1, 4]
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