CBRNE - Vomiting Agents - Dm, Da, Dc Follow-up

Updated: Aug 06, 2015
  • Author: Christopher P Holstege, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Follow-up

Further Outpatient Care

Most patients exposed to vomiting agents recover within the first few hours postexposure and demonstrate no further toxicity. If marked ocular toxicity occurs and corneal injury is documented, obtain follow-up care with an ophthalmologist to ensure that healing is progressing. Schedule this follow-up visit within 24 hours of discharge.

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Further Inpatient Care

Inpatient care for patients exposed to vomiting agents is no different than the care discussed in Emergency Department Care. Symptomatic patients exposed to these agents should remain in a health care setting until signs and symptoms abate and they are able to take adequate fluid by mouth without repeat emesis. Continued use of IV fluids and antiemetics may be necessary. Patients who demonstrate marked bronchospasm may need repeated nebulized albuterol as necessary.

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Transfer

A health care facility that is unable to adequately provide care for a patient intoxicated with a vomiting agent should consider transfer to a facility that can care for such patients. Health care facilities may be overwhelmed quickly if a large-scale exposure occurs with multiple casualties. Disaster plan implementation and appropriate transfer of patients to less stressed facilities may be necessary.

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Complications

Complications are expected to be rare in persons exposed to vomiting agents if rapid and adequate supportive care is initiated. Exceptions are as follows:

  • If significant ocular exposure occurs, corneal chemical burns may develop
  • In persons with preexisting lung disease, exacerbation of the lung disease may occur
  • If a patient sustains a large exposure, coma may develop, with subsequent risk of anoxic brain injury and aspiration pneumonia

Corneal chemical burns

Significant exposure to vomiting agents can lead to damage of the cornea. If the patient complains of significant eye discomfort, foreign body sensation, photophobia, or decreased visual acuity, consider eye irrigation. Thoroughly examine the eye and include visual acuity testing. Perform slit lamp examination with fluorescein. If a chemical corneal burn is documented, a cycloplegic may be used to reduce pain; apply topical antibiotic ointment. Arrange follow-up care with an ophthalmologist within 24 hours. For more information, see Ocular Burns.

Acute bronchospasm

As with many types of chemical inhalation exposures, acute bronchospasm may develop in patients exposed to vomiting agents. This is especially true of patients with preexisting lung disease (eg, asthma). If acute bronchospasm occurs leading to respiratory distress, treatment with bronchodilators (eg, albuterol) may be necessary.

Anoxic brain injury

If an exposed person becomes comatose and loses his or her ability to maintain ventilatory function, hypoxia may develop, leading to anoxic brain injury. Unless massive levels are encountered, this complication is exceedingly rare after exposure to vomiting agents.

Inability of exposed patients to maintain their airway may result in aspiration of gastric contents into the lungs, causing aspiration pneumonia

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Prognosis

The prognosis is good for persons exposed to vomiting agents if they do not develop secondary injuries. Full recovery is expected in most patients.

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Patient Education

For patient education resources, see the Bioterrorism and Warfare Center, as well as Chemical Warfare and Personal Protective Equipment.

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