CBRNE - Vesicants, Organic Arsenicals - L, ED, MD, PD, HL Workup

Updated: Mar 30, 2022
  • Author: Geoffrey M Fitzgerald, MD; Chief Editor: Zygmunt F Dembek, PhD, MS, MPH, LHD  more...
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Laboratory Studies

The US military and the North Atlantic Treaty Organization (NATO) have developed several field tests to detect various CW agents. The field tests that reliably detect L and the other organic arsenicals include the M256A1, individual chemical agent detector (ICAD), miniature chemical agent monitor (MINICAMS), M18A2, M21, M90, M93A1 Fox, chemical agent monitor (CAM), and depot area air monitoring system (DAAMS). Less sophisticated means of detection are M8 detection paper (turns red with lewisite [L]) and M9 paper (turns color when exposed to arsenicals).

With exception of urinary arsenic excretion, no specific tests exist for organic arsenical exposure. Leukocytosis and other nonspecific markers of tissue destruction may appear.

Culture damaged skin routinely to stave off opportunistic skin infections. Also perform sputum Gram stain and culture if the respiratory system is affected.


Imaging Studies

Pneumonia commonly follows pulmonary damage in 3-5 days. Obtain a chest x-ray as indicated.



Massive tissue damage to the respiratory mucosa can cause acute airway compromise from laryngospasm and/or necrotic debris. Emergent endotracheal intubation may be required. Obtain a bronchoscopy consultation if pseudomembrane formation is suggested.