Phosgene Oxime Exposure Medication

  • Author: Erik D Schraga, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Feb 9, 2011
 

Medication Summary

No medications are specific to the treatment of phosgene oxime exposure. Use analgesics and topical antibiotics as preferred by the emergency department physician.[9, 10]

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Parenteral analgesics

Class Summary

CX injuries are extremely painful and require liberal use of parenteral analgesics. No recommendations for specific parenteral analgesics are available. Select a medication (eg, morphine, meperidine) that is readily available and provides adequate pain relief for the patient.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

 

An alkaloid of opium and a commonly used systemic narcotic analgesic; a good first choice parenteral medication that may be titrated to patient needs.

Meperidine (Demerol)

 

Narcotic analgesic with multiple actions qualitatively similar to those of morphine, typically administered in conjunction with promethazine.

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Topical antibiotic ointments

Class Summary

Indicated for treatment of CX injury of skin and eyes; no specific ointments are recommended; select an available broad-spectrum ophthalmic or skin preparation (eg, bacitracin, Ilotycin).

Bacitracin (AK-Tracin, Baciguent)

 

Broad-spectrum antibiotic topical ointment that is a good first choice for superficial wound care.

Erythromycin ophthalmic (Ilotycin, E-mycin)

 

Broad-spectrum macrolide antibiotic indicated in treatment or prevention of superficial ocular infections.

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Oral analgesics

Class Summary

Patients may be switched from parenteral analgesics to an oral form once their injuries have improved sufficiently to tolerate alternative pain control measures; no specific recommendations are available; use a readily available product (eg, Percocet, Tylenol with codeine) that provides adequate pain relief and is well tolerated by the patient.

Oxycodone/acetaminophen (Percocet)

 

Semisynthetic opioid analgesic with multiple actions similar to those of morphine; acetaminophen is a nonopiate nonsalicylate analgesic and antipyretic.

Acetaminophen/codeine (Tylenol with codeine)

 

Combines analgesic effects of a centrally acting opium-derived alkaloid (codeine) and a peripherally acting nonopioid analgesic (acetaminophen).

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Contributor Information and Disclosures
Author

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Coauthor(s)

Andre Pennardt, MD, FACEP, FAAEM, FAWM  Clinical Associate Professor of Emergency Medicine, Medical College of Georgia; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Departments of Emergency Medicine, Aviation Medicine and Dive Medicine, Womack Army Medical Center

Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US, International Society for Mountain Medicine, National Association of EMS Physicians, Special Operations Medical Association, and Wilderness Medical Society

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  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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. Armstrong J. Chemical warfare. RN. Apr 2002;65(4):32-9. [Medline].

  2. Dang C. Chemical warfare agents. Top Emerg Med. 2002;24(2):25-39.

  3. McManus J, Huebner K. Vesicants. Crit Care Clin. Oct 2005;21(4):707-18, vi. [Medline].

  4. Rosenbloom M, Leikin JB, Vogel SN, Chaudry ZA. Biological and chemical agents: a brief synopsis. Am J Ther. Jan-Feb 2002;9(1):5-14. [Medline].

  5. Department of the Army. Phosgene oxime. In: Field Manual 8-285: Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries. 1995:IV-17-22.

  6. Zajtchuk R, Bellamy RF, eds. Phosgene oxime. In: Textbook of Military Medicine Part I: Medical Aspects of Chemical and Biological Warfare. 1997:220-222.

  7. McAdams AJ Jr, Joffe MH. A Toxico-pathologic Study of Phosgene Oxime. 1955. Army Medical Laboratories Research Report 381.

  8. Russell D, Blain PG, Rice P. Clinical management of casualties exposed to lung damaging agents: a critical review. Emerg Med J. Jun 2006;23(6):421-4. [Medline].

  9. ATSDR. Medical management guidelines for phosgene oxime. [Full Text].

  10. USAMRICD. Phosgene oxime. In: Medical Management of Chemical Casualties Handbook. 3rd ed. 2000:96-101.

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Anteroposterior portable chest radiograph in a male patient who developed phosgene-induced adult respiratory distress syndrome. Notice the bilateral infiltrates and ground glass appearance.
Chemical Terrorism Agents and Syndromes. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill, www.unc.edu/depts/spice/chemical.html.
 
 
 
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