Page 81 - 2023 SMOG Digital

CBRN

VESICANT BLISTER AGENTS

Vesicant Agents: Anticholinergics, PPE and Detection CRESS Symptomatic Presentation
Opioids, Riot Control • Mask C: Conscious (unconscious due to other effects)
• Lewisite (L), Mustard–Lewisite • AP-PPE R: Immediate irritation, distress
Mixture (HL) • JLIST or UIPE E: Immediate severe pain, blepharospasm edema
• Immediate Acting Agent M8 Detection Paper S: Normal to increased
• Oily liquid • Red to Pink S: Immediate pain, erythema, blisters form hours later
• Persistent, Freezing 0.4°F/-17°C LCD Detection OTHER: Systemic effects–distributive shock
• Odors: Geraniums • Red or Orange H
Immediate Action + M 2 A 2 R 2 E.
HOT ZONE POI • address MASSIVE HEMORRHAGE/Mask check Lewisite binds to tissues and absorbs systemically
• assess AIRWAY/administer ANTIDOTE (none in HOT
within two minutes of contact. Symptoms begin to
ZONE)
manifest immediately upon exposure and worsen
• asses RESPIRATIONS/conduct RAPID SPOT DECON
over time. Control of massive hemorrhage and
• Extract (move upwind, uphill, upstream–away from
rapid spot decon are top priorities.
threat) Extraction to the Dirty CCP [For Small Spills (<2
kg) move away 100m day/300m night] [Large Spills
Casualties with palm-size exposure without rapid
(<25kg) = 500m day/1000m night]
decon, >5% BSA burn, pulmonary edema, or
shock symptoms with rapid onset require chelation.
M 2 A 2 R 2 Reassessment Early pain control may be required to ensure
• Clear airway, O2 as needed, maintain filtered air casualty cooperation. Administration of BAL within
• ALBUTEROL (2.5mg in 3mL L NS)
5 minutes of exposure to skin and eyes can
WARM ZONE DIRTY CCP time, then wipe away) COUNTERMEASURE/TREATMENT
neutralize agent.
• Invasive airway if unresponsive to albuterol
Decontaminate and Cutout
• Remove and bag equipment, PPE, and clothing
Dimercaprol (BAL) Administration
• Wipe away gross contamination, RSDL cut line, cut out
• Initial Dose: 3mg/kg deep IM repeat q4hr for
• RSDL residual contamination on skin (>2min contact
two days
• Then: q12hr for 7-10 days
• Remove and replace contaminated treatments (chest
seals, tourniquets, etc.)
• Severe & Life Threating Exposure: consider 5
mg/kg
2
2
C H E
• CIRCULATION (asses vitals, resuscitate)
Nausea/vomiting, Headache, Anxiety, Injection
COUNTERMEASURES (rapid decon, irrigate eyes and
Necrosis
wounds with water) • Side Effects: Increased BP, Tachycardia,
• Prevent HYPOTHERMIA/assess mental status (altered • Contraindications: Nut Allergy.
due to agent or trauma?) HEAD INJURY
• EVACUATE to next role of care/zone Supportive Care
• PAIN MANAGEMENT
• Expect SIRS and ARDS in severe cases
(MARCHE)² Reassessment Mechanical Ventilations
• Use ARDS VENTILATOR MANAGEMENT
M²: Convert tourniquets & bandage wounds
COLD ZONE R²: Vesicant Inhalation Tx SOP, Ventilator, O 2 , PEEP, • Burns-apply Silvadene & bandage QID (burn CBRN
techniques
A²: In case of severe inhalation symptoms upgrade airway
Skin
adjunct & RSI
Suction, Bronchoscopy
fluid resuscitation not necessary
C²: Trend Vitals, TXA, FDP, FWB, Fluid Challenge if Req'd /
• Blister fluid may contain Arsenic, unroof >2cm,
severe exposures will present with distributive shock requiring
irrigate, calamine or steroidal cream
chelation therapy with Dimercaprol aka British Anti-Lewisite
Eyes
(BAL) in order to resolve
• H 2 : Hypothermia (HPMK, fluid warmer)/Head wounds
(treat elevated ICP, Neuro exam, MACE) HEAD INJURY
treat elevated ICP, conduct neuro exam, MACE • Petroleum based ophthalmic ointment,
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