Page 218 - PJ MED OPS Handbook 8th Ed

Emergency Care:
The most important action when caring for a vesicant-exposed patient is immediate removal of the
agent. Immediate irrigation with water or a chemical decontamination kit is crucial. Medical treat-
ment includes continuing irrigation and decontamination. The type and amount of irrigation used
is dependent on the available water supply. Ideally a hose (low pressure) provides plenty of water,
when necessary a canteen can be used because small amounts of irrigation are better than none.
Saline from an IV bag is also useful and particularly suited for eye irrigation. Never delay irrigation of
the eyes while searching for sterile solutions. Use plain, uncontaminated water instead.
Once blistering or other damage occurs, emergency care is the same as for ordinary chemical burns.
The fluid within the blisters caused by vesicants is sterile and exposure to this fluid will not cause
further injury. Dry sterile dressings are applied loosely. Severe eye injuries should be patched. Most
patients will experience significant pain and should receive 20mg IV or 50mg IM ketamine q15–
30min PRN. Unlike thermal burns, most serious vesicant patients do not require fluid resuscitation.

Cyanide:
Cyanide is a rapidly acting lethal agent that directly poisons the body’s cellular metabolism. Related
chemicals with similar toxicities include hydrogen cyanide (AC), cyanogen chloride (CK) and cyano-
gen bromide. Although it is a potent poison, cyanide is 25–50 times less toxic by inhalation route
than the nerve agent sarin.
Signs and Symptoms of Cyanide Poisoning
High Concentration Inhaled • 30–60 sec loss of • 2–3 min apnea
consciousness • 6–8 min cardiac arrest
• Convulsions
Ingestion or • Tachycardia • Nausea
Low Concentration Inhaled • Tachypnea • Weakness
• Dizziness • May progress to LOC, apnea
and death

Adult Dose and Administration of Cyanide Antidotes
Antidote Dose Route Comments
Oxygen High flow NRB/BVM Ventilatory support may be needed
Cyanokit 5mg/15min IV Reconstitute in 100mL NS per vial
(Hydroxycobalimin)
Sodium thiosulfate 25% 12.5g IV Alternative/second line treatment
Activated charcoal 50g (1g/kg ped) PO cyanide or organophosphate ingestion

Pulmonary agents:
Pulmonary agents include phosgene (CG), other halogen compounds and various nitrogen– oxygen
compounds. These agents act primarily to cause lung injury, hence the obsolete term “choking
agents”.

216 n Pararescue Medical Operations Handbook / 8th Edition