CBRNE - Lung-Damaging Agents, Toxic Smokes - NOx, HC, RP, FS, FM, SGF2, Teflon Medication
- Author: Lanny F Littlejohn, MD; Chief Editor: Robert G Darling, MD, FACEP more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Bronchodilators
Class Summary
These agents are important in the setting of bronchoconstriction and bronchorrhea. Toxic smokes can cause bronchoconstriction, especially if the exposed individual has underlying asthma or COPD.
Albuterol (Proventil, Ventolin)
Beta-agonist for bronchospasm refractory to epinephrine; relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility.
Anti-inflammatory agents
Class Summary
Although somewhat debated, steroids are believed to be helpful in toxic smoke inhalation, especially in metal fume fever, which is believed to be mediated by an inflammatory cascade of events involving cytokines and histamine release.
Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
Decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.
Chelating agents
Class Summary
No reports exist as to the efficacy of chelating agents; however, BAL and CaEDTA have been suggested because of their ability to reduce serum zinc levels.
Dimercaprol (BAL in oil)
DOC for treatment of mercury toxicity; administered IM q4h, mixed in a peanut oil base; although not formally indicated for zinc toxicity, has been suggested in the setting of severe HC inhalation since it lowers serum zinc levels.
CaEDTA (Disotate, Endrate, Chealamide)
Second drug used in lead toxicity; although mostly used in lead chelation, use has been associated with lowering serum zinc levels; begin therapy 4 h after BAL is given; only administered IV; continuous infusion is recommended.
Zinc toxicity may be treated with a combination of BAL and EDTA or with EDTA alone; Llobet et al studied 16 chelating agents as possible antidotes for acute zinc exposure in mice (Llobet, 1988); BAL and CaEDTA remain most commonly used in zinc toxicity; the combination approach has a higher incidence of nausea, vomiting, and elevated liver enzymes.
Adrenergic agonists
Class Summary
In profound bronchoconstriction and wheezing, SC epinephrine has been helpful in stabilizing mast cells and halting or reversing potentially fatal bronchoconstriction.
Epinephrine (Adrenalin, EpiPen, Bronitin)
DOC for treating anaphylactoid reactions; has alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability; beta-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.
Mydriatic agents
Class Summary
These agents relax any ciliary muscle spasm that can cause deep aching pain and photophobia.
Atropine ophthalmic (Atropisol, Atropair, Isopto)
Acts at parasympathetic sites in smooth muscle to block response of sphincter muscle of iris and muscle of ciliary body to acetylcholine, causing mydriasis and cycloplegia.
Alkalinizing agents
Class Summary
These agents are indicated for FS and FM cutaneous exposure.
Sodium bicarbonate
Rinse affected skin thoroughly before applying sodium bicarbonate solution. Potential exists for exothermic reaction (burns) whenever a base is mixed with an acid; therefore, after titanium chloride or FS exposure, rinse affected skin thoroughly and copiously with water or saline. Pharmacists at Walter Reed Medical Center recommend a 5% solution of sodium bicarbonate to rinse over affected area, followed by rinsing copiously with water or saline. The author feels that copious irrigation alone with water or saline should be sufficient, along with proper wound care, rather than introducing another chemical onto an already irritated area of skin.
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