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CBRN

PULMONARY AGENTS

Pulmonary Agents: Phosgene, PPE and Detection CRESS Symptomatic Presentation
Chlorine • Mask (C2–A1 Filter) C: conscious (unconscious if asphyxia)
• Phosgene, Chlorine • AP-PPE R: normal to respiratory distress, delayed onset up to
• Gas (CoCl 2 ) above 47°F/8.3°C • JLIST or UIPE 24 hours (phosgene)
• Gas (Cl) above 29°F/-1.6°C E: irritated, injected (chlorine)
• Odor Phosgene: freshly mowed M8 Detection Paper S: Mucous membrane irritation (rhinorrhea, salivation)
hay • Not effective S: Chlorine: immediate irritation (tearing and
• Phosgene toxic below odor rhinorrhea) Phosgene: delayed fluid buildup
threshold There is no antidote for Chlorine or Phosgene
HOT ZONE POI Immediate Action + M 2 A 2 R 2 E. PHOSGENE: Onset of symptoms can be delayed
2
2
2
exposure. Treatment focus is remove from
• address MASSIVE HEMORRHAGE / Mask check
exposure, aggressive management of airway
• assess AIRWAY / administer ANTIDOTE
and respirations, supportive care.
• asses RESPIRATIONS / conduct RAPID SPOT DECON
• Extract (move upwind, uphill, upstream – away from
up to 24 hours, generally 2–6 hours after exposure.
threat)
Exertion is associated with worse outcomes, so
keep patients exposed to phosgene at rest. The
major effects of phosgene are on peripheral
M 2 A 2 R 2 Reasses ssment airways, therefore dyspnea, chest tightness or pain,

s
2

• Cl ear airway (copious secretions) and cough are common symptoms. Development of
• Anticipate laryngospasms hypoxia and pulmonary edema. Fluid shifts
WARM ZONE DIRTY CCP not be sufficient, ARDS technique, need to manipulate Chlorine: Onset of symptoms are immediate.
secondary to pulmonary edema may result in
• Place advanced airway (largest bore ET as able), be
prepare to conduct cricothyroidotomy for failed airway
hypovolemia.
• Advanced Ventilatory support (SAVe or simple vent may
Chlorine causes more immediate symptoms in the
peep, volume, FiO 2 )
moist areas of the eyes, mouth, and upper airways.
• O2 as needed, maintain air filter
Eye pain, blepharospasm, and lacrimation are
Decontaminate and Cutout
common. Other symptoms may include headache,
• Remove and bag equipment, PPE, and clothing
salivation, dyspnea, cough, hemoptysis, chest
• Soap and water sufficient for skin decon
• Remove and replace contaminated treatments (chest
burning.
seals, tourniquets, etc.)
2
C H E burning, and vomiting. Irrigate eyes if irritated or
2
Laryngospasm may occur with both Phosgene and
• CIRCULATION (asses vitals) COUNTERMEASURES Chlorine. Anticipate airway edema and manage
• Prevent HYPOTHERMIA / assess mental status (altered airway early. If advanced airway required, place
due to agent or trauma?) HEAD INJURY largest endotracheal tube possible to facilitate
• EVACUATE to next role of care/zone suctioning. Intravenous fluids may be necessary in
the setting of volume depletion, but should not be
given empirically. Fluid overload can contribute to
MARCHE 2 Reassessment pulmonary edema and should be avoided.
COLD ZONE • continue CIRCULATION support (monitor vitals), b bronchospasms:
• Continue to address any immediate life threats
• provide AIRWAY and RESPIRATORY support as
Consider following for wheezing/
necessary, provide supplemental O2 even with normal
CBRN
SpO2
• ALBUTEROL (2.5mg in 3mL L NS)
• METHYPREDNISOLONE (125mg IV)
resuscitate as necessary/COUNTERMEASURES 2 nd
• See RESPIRATORY DISTRESS
dose as appropriate)
• prevent HYPOTHERMIA with HPMK, warm fluids/HEAD
Mechanical Ventilations
INJURY treat elevated ICP, conduct neuro exam, MACE
• Use ARDS VENTILATOR MANAGEMENT
techniques
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