CBRNE - Lung-Damaging Agents, Toxic Smokes - NOx, HC, RP, FS, FM, SGF2, Teflon Follow-up

  • Author: Lanny F Littlejohn, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: May 14, 2010
 

Further Outpatient Care

Although most individuals recover without lasting sequelae, some relapse into an acute pulmonary syndrome or develop chronic changes in pulmonary function. Obtain serial PFTs to evaluate progression or deterioration in lung function.

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Deterrence/Prevention

In the military setting, the mission-oriented protective posture (MOPP) gear ensemble provides adequate protection against all smokes. In the industrial setting, guidelines have been established for the protection of the worker as well as any person who may come in contact with toxic smokes. Aim preventive efforts at decreasing the concentration of the smoke and the time of exposure and recognizing underlying health problems that may be exacerbated by exposure to toxic smokes.

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Prognosis

  • The prognosis for mild-to-moderate exposures of toxic smokes is generally very good, with the usual outcome return to full recovery without sequelae.
  • Metal fume fever is self-limited and usually resolves after a short period of observation.
  • Exposure to white smoke (HC) in a military setting can lead to acute lung injury (ALI) and in severe cases acute respiratory distress syndrome (ARDS).
  • With more severe exposures, lungs may become severely damaged and develop chronic pulmonary fibrosis.
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Patient Education

For excellent patient education resources, visit eMedicine's Bioterrorism and Warfare Center and Poisoning Center. Also, see eMedicine's patient education articles Chemical Warfare, Personal Protective Equipment, Smoke Inhalation, and Carbon Monoxide Poisoning.

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Contributor Information and Disclosures
Author

Lanny F Littlejohn, MD  Staff Emergency Physician and Medical Director for Tactical Combat Casualty Care, Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia

Lanny F Littlejohn, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Special Operations Medical Association, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

William Byrne Cogar, DO, FACEP  Medical Director, Emergency Management and Preparedness; Assistant Chair, Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA

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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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. Hsu HH, Tzao C, Chang WC, Wu CP, Tung HJ, Chen CY. Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high-resolution CT findings, and pulmonary function test results. Chest. Jun 2005;127(6):2064-71. [Medline].

  2. Conner MW, Flood WH, Rogers AE, Amdur MO. Lung injury in guinea pigs caused by multiple exposures to ultrafine zinc oxide: changes in pulmonary lavage fluid. J Toxicol Environ Health. 1988;25(1):57-69. [Medline].

  3. Marrs TC, Colgrave HF, Edginton JA, Brown RF, Cross NL. The repeated dose toxicity of a zinc oxide/hexachloroethane smoke. Arch Toxicol. 1988;62(2-3):123-32. [Medline].

  4. Keyes DC. Metal fume fever. In: Dart RC. Medical Toxicology. 3rd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 2004:88-89.

  5. Kuschner WG, D'Alessandro A, Wong H, Blanc PD. Early pulmonary cytokine responses to zinc oxide fume inhalation. Environ Res. Oct 1997;75(1):7-11. [Medline].

  6. Loh CH, Chang YW, Liou SH, Chang JH, Chen HI. Case report: hexachloroethane smoke inhalation: a rare cause of severe hepatic injuries. Environ Health Perspect. May 2006;114(5):763-5. [Medline].

  7. Roney N, Smith CV, Williams M. Toxicological Profile for Zinc (Update). US Dept of Health & Human Services -- PHS. 2007;[Full Text].

  8. Chou CH, Kao TW, Liou SH, Chen HI, Ku HY, Chuang HJ, et al. Hematological abnormalities of acute exposure to hexachloroethane smoke inhalation. Inhal Toxicol. May 2010;22(6):486-92. [Medline].

  9. Huang K, Chen C, Chu S, et al. Systemic inflammation caused by white smoke inhalation in a combat exercise. Chest. 2008;133:722-728. [Medline]. [Full Text].

  10. Akbar-Khanzadeh F. Short-term respiratory function changes in relation to workshift welding fume exposures. Int Arch Occup Environ Health. 1993;64(6):393-7. [Medline].

  11. Bylin G. Health risk evaluation of nitrogen oxide. Controlled studies on humans. Scand J Work Environ Health. 1993;19 Suppl 2:37-43. [Medline].

  12. Departments of the Army, the Navy, and the Air Force, and Commandant Marine Corps. Smokes. In: Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries. Part 2. Conventional Military Chemical Injuries. 1995;chap 8. [Full Text].

  13. do Pico GA. Toxic fume inhalation. In: Pulmonary and Critical Care Medicine. Vol 2. 1993:11-12.

  14. Duerksen-Hughes P, Richter P, Ingerman L. Toxicological Profile for White Phosphorus. US Dept of Health & Human Services -- PHS;1997.

  15. Gordon T, Chen LC, Fine JM, Schlesinger RB, Su WY, Kimmel TA. Pulmonary effects of inhaled zinc oxide in human subjects, guinea pigs, rats, and rabbits. Am Ind Hyg Assoc J. Aug 1992;53(8):503-9. [Medline].

  16. Johnston CJ, Finkelstein JN, Gelein R, Baggs R, Oberdorster G. Characterization of the early pulmonary inflammatory response associated with PTFE fume exposure. Toxicol Appl Pharmacol. Sep 1996;140(1):154-63. [Medline].

  17. Johnston CJ, Finkelstein JN, Mercer P, Corson N, Gelein R, Oberdorster G. Pulmonary effects induced by ultrafine PTFE particles. Toxicol Appl Pharmacol. Nov 1 2000;168(3):208-15. [Medline].

  18. Little JD, Liccione J, Iannucci A. Toxicological Profile for Sulfur Trioxide and Sulfuric Acid. US Dept of Health & Human Services -- PHS. 1998.

  19. Llobet JM, Domingo JL, Corbella J. Antidotes for zinc intoxication in mice. Arch Toxicol. 1988;61(4):321-3. [Medline].

  20. Murray E, Llados F. Toxicological Profile for Titanium Tetrachloride. US Dept of Health and Human Services -- PHS. 1997.

  21. Patel MM, Miller MA, Chomchai S. Polymer fume fever after use of a household product. Am J Emerg Med. Nov 2006;24(7):880-1. [Medline].

  22. Paulsen SM, Nanney LB, Lynch JB. Titanium tetrachloride: an unusual agent with the potential to create severe burns. J Burn Care Rehabil. Sep-Oct 1998;19(5):377-81. [Medline].

  23. Samet JM, Utell MJ. Air pollution. In: Bone RC, ed. Pulmonary and Critical Care Medicine. Vol 2. 1993:7-12.

  24. Selgrade MK, Hatch GE, Grose EC, Illing JW, Stead AG, Miller FJ. Pulmonary effects due to short-term exposure to oil fog. J Toxicol Environ Health. 1987;21(1-2):173-85. [Medline].

  25. Selgrade MK, Hatch GE, Grose EC, Stead AG, Miller FJ, Graham JA. Pulmonary effects due to subchronic exposure to oil fog. Toxicol Ind Health. Jan 1990;6(1):123-43. [Medline].

  26. Stueven HA, Coogan P, Valley V. A hazardous material episode: sulfur trioxide. Vet Hum Toxicol. Feb 1993;35(1):37-8. [Medline].

  27. Urbanetti JS. Toxic inhalational injury. In: Medical Aspects of Chemical and Biological Warfare. 1997:260-267. [Full Text].

 
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