CBRNE - Vesicants, Mustard - Hd, Hn1-3, H Follow-up

Updated: Jan 02, 2018
  • Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Follow-up

Further Outpatient Care

For 12 hours prior to discharge, observe patients who are exposed to mustard and who are initially asymptomatic.

Chronic health problems may develop after mustard exposure including respiratory diseases (asthma, pulmonary fibrosis, bronchiectasis), skin lesions (dermal scarring), neoplasms (gastrointestinal cancers, chronic myelocytic leukemia, respiratory cancers, and skin cancers), and ocular problems (keratitis, corneal ulcers, conjunctivitis).

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Further Inpatient Care

Patients with moderate-to-severe cutaneous effects are best managed in a hospital burn unit. The period of recuperation is much longer than that for thermal burns. Patients with significant pulmonary involvement usually require ICU admission.

Topical combination therapy with zinc desferrioxamine and dexamethasone resulted in faster corneal reepithelization and less severe neovascularization in an animal model. Keratoplasty may be necessary to recover visual function.

Adequate nutrition and fluid and electrolyte replacement are mandatory for patients with severe poisonings who have vomiting, diarrhea, leukopenia, hemoconcentration, and shock.

Patients with severe leukopenia require isolation and may require appropriate antibiotics. Colony-stimulating factors, such as filgrastim and pegfilgrastim, may help reduce the incidence of life-threatening infections associated with neutropenia. [4, 6]

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Deterrence/Prevention

The Israel Defense Force is developing a topical skin protectant (IB1) that is a passive protective lotion and, when applied before exposure, may significantly reduce the toxicity of sulfur mustard chemical warfare agents. [9]

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Patient Education

For patient education information, see Chemical Warfare and Personal Protective Equipment.

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