Phosgene Oxime Exposure Treatment & Management

Updated: Jun 24, 2016
  • Author: Erik D Schraga, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Treatment

Prehospital Care

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. [10, 11]

Administer sufficient doses of systemic analgesics as soon as possible.

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Emergency Department Care

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, 10, 11] Verify complete decontamination to ensure that no medical personnel become casualties.

Airway and/or pulmonary  [9]

Considerations include the following:

  • 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 management

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

Eyes

Apply topical antibiotics 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.

Skin

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

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Consultations

See the list below:

  • Consult ophthalmology to provide close follow-up care for significant ocular exposures.

  • Consult plastic surgery for severe dermal damage.

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