Diphosgene Exposure Treatment & Management

Updated: Jan 05, 2016
  • Author: Paul P Rega, MD, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Treatment

Prehospital Care

See the list below:

  • Scene responders need to ensure their own safety when possible to prevent becoming victims themselves.
  • Remove patients from the scene and move them to fresh air or administer oxygen if necessary.
  • Terminate exposure by removing patients' clothing. Begin skin decontamination with soap and water.
  • Pulmonary edema may be precipitated by exertion. Enforce strict bedrest if possible.
  • No antidote exists.
  • Management is supportive.
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Emergency Department Care

See the list below:

  • Management is supportive.
  • An antidote does not exist.
  • Begin or continue care as discussed in Prehospital Care above.
  • Minimize exertion on the part of the patient so as to lessen the risk of delayed pulmonary edema.
  • Administer standard resuscitation measures. Patients can present with airway obstruction, although this situation is rare. Acute pulmonary edema is common, and patients may require positive end-expiratory pressure if they are clinically in respiratory distress or frank failure. Avoid use of diuretics. Patients also can present with hypotension; perform standard resuscitation with crystalloid fluids as first-line agents and vasopressors as second-line agents.
  • Give bronchodilators to patients with bronchospasm. Systemic steroids likely are not beneficial routinely for diphosgene (DP) exposure, except in patients with bronchospasm not controlled by bronchodilators. Some literature suggests using inhalational steroids for phosgene poisoning, which may lessen the severity of pulmonary edema. Similar regimens possibly may be used for diphosgene inhalation. However, initiate treatment within a short time of exposure (15 min). One regimen uses dexamethasone and another uses betamethasone or beclomethasone in doses higher than that prescribed for asthma therapy.
  • Eyes should be copiously irrigated with standard solutions and then assessed for visual acuity and corneal damage.
  • Contact with liquid diphosgene may produce chemical burns and, after thorough decontamination, may be treated with standard burn therapy.
  • Antibiotics are unnecessary, prophylactically or therapeutically, unless a secondary infection is present.
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Consultations

See the list below:

  • Consult an ophthalmologist for a significant eye injury.
  • Consult a pulmonologist in the event of significant respiratory exposure.
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