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CBRNE - Vomiting Agents - Dm, Da, Dc Follow-up

  • Author: Christopher P Holstege, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
 
Updated: Aug 06, 2015
 

Further Outpatient Care

Most patients exposed to vomiting agents recover within the first few hours postexposure and demonstrate no further toxicity. If marked ocular toxicity occurs and corneal injury is documented, obtain follow-up care with an ophthalmologist to ensure that healing is progressing. Schedule this follow-up visit within 24 hours of discharge.

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Further Inpatient Care

Inpatient care for patients exposed to vomiting agents is no different than the care discussed in Emergency Department Care. Symptomatic patients exposed to these agents should remain in a health care setting until signs and symptoms abate and they are able to take adequate fluid by mouth without repeat emesis. Continued use of IV fluids and antiemetics may be necessary. Patients who demonstrate marked bronchospasm may need repeated nebulized albuterol as necessary.

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Transfer

A health care facility that is unable to adequately provide care for a patient intoxicated with a vomiting agent should consider transfer to a facility that can care for such patients. Health care facilities may be overwhelmed quickly if a large-scale exposure occurs with multiple casualties. Disaster plan implementation and appropriate transfer of patients to less stressed facilities may be necessary.

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Complications

Complications are expected to be rare in persons exposed to vomiting agents if rapid and adequate supportive care is initiated. Exceptions are as follows:

  • If significant ocular exposure occurs, corneal chemical burns may develop
  • In persons with preexisting lung disease, exacerbation of the lung disease may occur
  • If a patient sustains a large exposure, coma may develop, with subsequent risk of anoxic brain injury and aspiration pneumonia

Corneal chemical burns

Significant exposure to vomiting agents can lead to damage of the cornea. If the patient complains of significant eye discomfort, foreign body sensation, photophobia, or decreased visual acuity, consider eye irrigation. Thoroughly examine the eye and include visual acuity testing. Perform slit lamp examination with fluorescein. If a chemical corneal burn is documented, a cycloplegic may be used to reduce pain; apply topical antibiotic ointment. Arrange follow-up care with an ophthalmologist within 24 hours. For more information, see Ocular Burns.

Acute bronchospasm

As with many types of chemical inhalation exposures, acute bronchospasm may develop in patients exposed to vomiting agents. This is especially true of patients with preexisting lung disease (eg, asthma). If acute bronchospasm occurs leading to respiratory distress, treatment with bronchodilators (eg, albuterol) may be necessary.

Anoxic brain injury

If an exposed person becomes comatose and loses his or her ability to maintain ventilatory function, hypoxia may develop, leading to anoxic brain injury. Unless massive levels are encountered, this complication is exceedingly rare after exposure to vomiting agents.

Inability of exposed patients to maintain their airway may result in aspiration of gastric contents into the lungs, causing aspiration pneumonia

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Prognosis

The prognosis is good for persons exposed to vomiting agents if they do not develop secondary injuries. Full recovery is expected in most patients.

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Patient Education

For patient education resources, see the Bioterrorism and Warfare Center, as well as Chemical Warfare and Personal Protective Equipment.

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Contributor Information and Disclosures
Author

Christopher P Holstege, MD Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Chief, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, Medical Society of Virginia, Society of Toxicology, Wilderness Medical Society, European Association of Poisons Centres and Clinical Toxicologists, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

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.

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