Diphosgene Exposure Follow-up

Author: Paul P Rega, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP more...

Updated: Jun 3, 2011

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Further Inpatient Care

Admit patients who require resuscitation or oxygen supplementation.
For at least 12 hours, observe patients with likely diphosgene exposure who have minor symptoms or are asymptomatic, since delayed pulmonary edema is the classic feature of diphosgene exposure. However, one reference suggests that a minimum of 6 hours of observation is sufficient for a phosgene exposure.^[1]
Counsel all patients with significant exposure to avoid strenuous activities for 72 hours and to return if significant respiratory symptoms develop.

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.
Alert the patient about returning to the emergency department or contacting 911 if there is any evidence of respiratory changes such coughing, wheezing, or shortness of breath.

Contributor Information and Disclosures

Author

Paul P Rega, MD, FACEP Assistant Professor, Department of Public Health and Preventive Medicine, The University of Toledo College of Medicine; Assistant Professor, Department of Emergency Medicine, The University of Toledo College of Medicine; Director of Emergency Medicine Education and Disaster Management, OMNI Health Services

Paul P Rega, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Keim, MD Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

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.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Eric Mowatt-Larssen, MD, and Timothy Vollmer, MD, to the development and writing of this article.

References

American Academy of Orthopedic Surgeons, Stewart CE. Pulmonary Agents. In: Stewart CE. Weapons of Mass Casualties and Terrorism Response Handbook. Boston: Jones & Bartlett; 2006:42 (Ch.4).
Chemical Casualty Care Division USAMRICD. Medical Response to Chemical Warfare and Terrorism. 3^rd ed. 1997:i-xiv, 1-8.
Choking Agents. Defense Treaty Inspection Readiness Program. Available at http://dtirp.dtra.mil/tic/treatyinfo/vd_comp05.htm. Accessed June 13, 2007.
Compton JAF. Diphosgene. In: Military Chemical and Biological Agents. 1987:124-134.
Givens M. Phosgene and toxic gases. In: Keyes DC, Burstein LJ, et al, eds. Medical Response to Terrorism, Preparedness and Clinical Practice. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005.
Lillie SH, Hanlon E, Kelly JM, eds. Potential Military Chemical/Biological Agents and Compounds (FM3-11.9). Jan 2005.
Micromedex. PoisinDex [Web site]. Phosgene. Accessed September 8, 2000.
Nelson LS. Simple asphyxiants and pulmonary irritants. In: Goldfrank's Toxicologic Emergencies. 6^th ed. 1998:1523-1538.
Traub SJ. Respiratory agent attack (toxic inhalational injury). In: Ciottone GR, Anderson PD, Auf Der Heide E, Darling RG, Jacoby I, Noji E, Suner S, eds. Disaster Medicine. 3^rd ed. Philadelphia, PA: Mosby/Elsevier; 2006:chap 93; 573-575.
Urbanetti JS. Toxic inhalation injury. In: Textbook of Military Medicine. Part 1. 1997:247-270.
US Army. Diphosgene. General Reimer Digital Library [Web site]. Accessed September 27, 2000.

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