Page 96 - 2022 Ranger Medic Handbook

VESICANTS MUSTARD (H) and LEWISITE (L)
MARCH PPE AND DECON CONSIDERATIONS
M – Massive hemorrhage/Mask check: ensure the • Mask recommended.
patient has good mask seal • Wear a minimum of two (2) pairs of nitrile exam
gloves IOT put hands on patient
A – Airway/Antidote: no antidote for vesicant, however, • Ensure patient is masked or has protected airway to
ensure good and early airway management
SECTION 2 R – Respirations/Rapid DECON: positive pressure • DECON with RSDL, to include wounds and eyes if
prevent inhalation injuries
ventilations and rapid spot DECON
C – Circulation/Countermeasures: start IV
needed. Soap and water also work well.
H – Hypothermia/Head injury: treat this patient like a
burn patient for hypothermia • DRY-WET-DRY
IMMEDIATE CONSIDERATIONS PFC CONSIDERATIONS
• Patients with severe pulmonary symptoms within • 20% TBSA burned: 2 injections Pegfilgrastim 6mg
4–6 hours OR TBSA of more than 50% should be SQ day 1/7.
considered expectant • Significant absorption of sulfur mustard can cause
• Maintain 30–50mL/hr UOP injury to bone marrow, lymph nodes, and spleen
• Manage airway aggressively if evidence of upper causing a drop in white blood cells (beginning on
airway burns or fluid accumulation: nebulized days 3–5).
albuterol – 3mL (0.083%), Consider: nebulized • Acute respiratory distress syndrome (ARDS) may
racemic epinephrine: 0.5mL of 2.25% solution in 3mL develop hours to days post exposure
NS, Solu-Medrol 125mg IM/IV • Severe eye lesions need to be treated with
• Flush eyes with saline/water to pH 7.0, tetracaine ophthalmic steroid/antibiotic combination: Tobrex is
2gtt OU current standard
• Treat vesicant exposure (with immediate pain) with • Pulmonary toilet for pseudomembranous formation
British anti-Lewisite (BAL; dimercaprol) – 3mg/kg IM • Silverlon Bandage/Silvadene Cream
TOXIC INDUSTRIAL CHEMICALS/MATERIALS
(CHLORINE/PHOSGENE/CYANOGENS)
MARCH PPE AND DECON CONSIDERATIONS
M – Massive hemorrhage/Mask check: ensure the • As always use of mask recommended.
patient has good mask seal • Wearing a minimum of two (2) pairs of nitrile exam
A – Airway/Antidote: no antidote for chlorine or gloves will provide needed protection IOT put hands
phosgene; however, ensure good and early airway on patient.
management, O 2 ASAP and Cyanokit for cyanide • Ensure patient is masked or has protected airway to
if available prevent inhalation injuries
R – Respirations/Rapid DECON: positive pressure • DECON with RSDL, to include wounds and eyes
ventilations and rapid DECON with physical removal of if needed. Soap and water also work well.
clothing and any liquids on skin
C – Circulation/Countermeasures: circulatory support
H – Hypothermia/Head injury
IMMEDIATE CONSIDERATIONS PFC CONSIDERATIONS
• One immediate finding is CNS depression due to • Multiple patients: (may run out of CyanoKit, use
hypoxia; however, cyanogens will cause a drop in BP sodium nitrite). Consider sodium nitrite: 300mg of
so ensure proper circulatory support. Give CyanoKit a 3% solution (10mL of a 3% solution) over 5–20
(× 2 if inadequate response to first) minutes
• 92% O 2 (titrate to effect) with positive pressure • Absolute bedrest 36 hours
ventilations due to pulmonary edema, supportive • Monitor patient for ARDS, may be delayed up to
care 72 hours
• Manage airway aggressively if evidence of upper • If patient survives first 48 hours, recovery is likely
airway burns or fluid accumulation: nebulized
albuterol 3mL (0.083%); consider nebulized racemic
epinephrine 2.25% in 15-30mL, Solu-Medrol 125mg
IM/IV.
• Flush eyes with saline/water to pH 7.0, tetracaine
2gtt OU.
82 SECTION 2 PRIMARY TRAUMA PROTOCOLS