Phosgene Oxime Exposure Treatment & Management

Removal of casualties from the source of exposure and rapid decontamination are the key aspects of prehospital care. Decontamination consists of removal of all clothing, wiping all gross materials from skin, rinsing with copious amounts of soap and water, washing with 0.5% hypochlorite solution, or use of resin compounds.

Administer oxygen to patients with significant respiratory distress. Endotracheal intubation and ventilatory support may be required for patients with severe airway exposures or progressive pulmonary symptoms. ^{[12, 13]}

Administer sufficient doses of systemic analgesics as soon as possible.

Emergency department care is a continuation of prehospital care and is supportive in nature. No antidotes exist for phosgene oxime exposure. Although corticosteroid treatment has been given to patients exposed to chlorine gas, which causes a similar syndrome, evidence is limited on its efficacy and safety in the treatment of phosgene exposure. ^{[5, 12, 13]} Verify complete decontamination to ensure that no medical personnel become casualties.

Airway and/or pulmonary include the following: ^[11]

• Be alert to the possible need for airway management in patients with severe exposure
• Administer oxygen to patients with significant respiratory symptoms
• Provide supportive care for noncardiogenic pulmonary edema, as required

Pain associated with CX exposure is nearly unbearable. Ensure that adequate systemic, preferably parenteral, analgesics are administered.

Apply topical antibiotics to eye lesions to reduce risk of infection and adhesions. Topical anticholinergics may reduce the risk of future synechiae formation. Eye lesions require the same care as would be done for damage from a corrosive substance.

Initiate wound management as appropriate for any other necrotic and/or ulcerated lesion. 

Admit any patients demonstrating significant respiratory symptoms for observation and supportive care. Transfer to a higher-level medical center may be required for severe pulmonary CX injuries if the initial hospital is unable to provide the necessary intensive care support. Secure the airway and initiate ventilatory support prior to transfer.

Pain associated with phosgene oxime (CX) exposure typically remains severe for several days. Consider admission for pain control. Inpatient medications include the following:

• Parenteral analgesics (eg, morphine, meperidine)
• Broad-spectrum ophthalmic antibiotic ointments for eye injuries
• Broad-spectrum topical antibiotic ointments for skin burns

Patients may be treated on an outpatient basis once respiratory symptoms have resolved and nonparenteral analgesics are adequate for pain control. Outpatient medications include oral analgesics (eg, codeine, oxycodone) if continued pain management is required after discharge and continued antibiotic ointments for eye and skin injuries until full healing has occurred.

Instruct the patient on appropriate wound care techniques and provide close follow-up care to the patient to ensure adequate healing. Ophthalmology follow-up care to ensure resolution of ocular injuries also is important.

Consult ophthalmology to provide close follow-up care for significant ocular exposures. Consult plastic surgery for severe dermal damage.