Diphosgene Exposure Treatment & Management

  • Author: Paul P Rega, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 3, 2011
 

Prehospital Care

  • Scene responders need to ensure their own safety when possible to prevent becoming victims themselves.
  • Remove patients from the scene and move them to fresh air or administer oxygen if necessary.
  • Terminate exposure by removing their clothing. Begin skin decontamination with soap and water.
  • Pulmonary edema may be precipitated by exertion. Enforce strict bedrest if possible.
  • No antidote exists.
  • Management is supportive and avoiding exertion.
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Emergency Department Care

  • Management is supportive.
  • An antidote does not exist.
  • Begin or continue care as discussed in Prehospital Care above.
  • Minimize exertion on the part of the patient so as to lessen the risk of delayed pulmonary edema.
  • Administer standard resuscitation measures. Patients can present with airway obstruction, although this situation is rare. Acute pulmonary edema is common, and patients may require positive end-expiratory pressure if they are clinically in respiratory distress or frank failure. Avoid use of diuretics. Patients also can present with hypotension; perform standard resuscitation with crystalloid fluids as first-line agents and vasopressors as second-line agents.
  • Give bronchodilators to patients with bronchospasm. Systemic steroids likely are not beneficial routinely for diphosgene (DP) exposure, except in patients with bronchospasm not controlled by bronchodilators. Some literature suggests using inhalational steroids for phosgene poisoning, which may lessen the severity of pulmonary edema. Similar regimens possibly may be used for diphosgene inhalation. However, initiate treatment within a short time of exposure (15 min). One regimen uses dexamethasone and another uses betamethasone or beclomethasone in doses higher than that prescribed for asthma therapy.
  • Eyes should be copiously irrigated with standard solutions and then assessed for visual acuity and corneal damage.
  • Contact with liquid diphosgene may produce chemical burns and, after thorough decontamination, may be treated with standard burn therapy.
  • Antibiotics are unnecessary, prophylactically or therapeutically, unless a secondary infection is present.
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Consultations

  • Consult an ophthalmologist for a significant eye injury.
  • Consult a pulmonologist in the event of significant respiratory exposure.
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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

  1. 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).

  2. Chemical Casualty Care Division USAMRICD. Medical Response to Chemical Warfare and Terrorism. 3rd ed. 1997:i-xiv, 1-8.

  3. Choking Agents. Defense Treaty Inspection Readiness Program. Available at http://dtirp.dtra.mil/tic/treatyinfo/vd_comp05.htm. Accessed June 13, 2007.

  4. Compton JAF. Diphosgene. In: Military Chemical and Biological Agents. 1987:124-134.

  5. 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.

  6. Lillie SH, Hanlon E, Kelly JM, eds. Potential Military Chemical/Biological Agents and Compounds (FM3-11.9). Jan 2005.

  7. Micromedex. PoisinDex [Web site]. Phosgene. Accessed September 8, 2000.

  8. Nelson LS. Simple asphyxiants and pulmonary irritants. In: Goldfrank's Toxicologic Emergencies. 6th ed. 1998:1523-1538.

  9. 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. 3rd ed. Philadelphia, PA: Mosby/Elsevier; 2006:chap 93; 573-575.

  10. Urbanetti JS. Toxic inhalation injury. In: Textbook of Military Medicine. Part 1. 1997:247-270.

  11. US Army. Diphosgene. General Reimer Digital Library [Web site]. Accessed September 27, 2000.

 
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