CBRNE - Vesicants, Mustard - Hd, Hn1-3, H Workup

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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Workup

Laboratory Studies

No hospital laboratory test exists to identify or quantify mustard exposures, since mustard is biotransformed and bound to tissues within minutes of adsorption.

Obtain a complete blood count, serum electrolytes, and coagulation studies; observe these periodically in all patients except those with isolated mild ocular or cutaneous involvement. Leukocytosis occurs during the first day. After large systemic adsorption, leukopenia may begin on day 3-5. A leukocyte count of 500/μL or less is an unfavorable prognostic sign.

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Other Tests

The US military has the capability of detecting mustard agents in the environment with the use of the M256A1, M272 water testing kit, miniature chemical agent monitor (MINICAMS), individual chemical agent detector (ICAD), M18A2, M21 remote sensing alarm, M90, M93A1 Fox, Bubbler, chemical agent monitor (CAM), depot area air monitoring system (DAAMS), and M8 or M9 chemical detection paper.

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Chest Radiography

Mustards may cause a chemical pneumonitis. Secondary infection may lead to lobular or lobar consolidation. Radiographic appearance follows the characteristics of the type of secondary pneumonia.

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