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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Chemical/Radiological Principles,CHEMICAL TERRORISM,OBJECTIVES,Learn how to perform a rapid assessment of a nerve agent terrorism situation.,Recognize characteristic signs and symptoms of nerve agent poisoning.,OBJECTIVES,Understand proper decontamination for nerve agent poisoning.,Learn medical management of nerve agent exposed victims.,Learn specific antidotes for nerve agent poisoning victims.,An unknown gas is released in the downtown rapid transit station.It is described as a thick mist,and was found in 5 separate stops.Thousands of commuters rapidly fled the stations to the streets.EMS transport is overwhelmed,and several local EDs are unable to absorb the patients presenting by ambulance,car,taxi,and on foot.,Many patients present to offices and local health departments.,Scenario,Friday,January 31 8:47 AM,(Rush Hour),One patient that presents to a local health clinic complains of tearing and runny nose.He also has mild shortness of breath.Mild wheeze is noted on exam.,Ten other patients at the clinicare asymptomatic,but are very worried.,Scenario,Friday,January 31 10:02 AM,Public health officials confirm that the gas was Sarin,similar to the toxin used in the subway of Tokyo.,Scenario,Friday,January 31 10:27 AM,Has your staff been adequately trained about chemical weapons?,Does your staff understand basic principles of decontamination?,Who should your staff alert?,Who will alert your staff in the event of a chemical terrorism event?,Things to Consider,Nerve Agents,Liquids that disseminate in the vapor/aerosolized form,Onset is abrupt(seconds to hours),Designed to irritate,incapacitate,injure or kill,Predominantly inhalational and dermal threats,If death occurs,usually respiratory cause,Characteristics of Nerve Agents,Chemical incidents are obvious shortly after exposure.,Biological agents will take days to cause symptoms.,ONE patient can contaminate your facility,First responders/health care providers are in the line of fire,Characteristics of Nerve Agents,First used as a weapon during WWI,Most recent event-Japanese subway incident in 1995,Aum Shinrikyo cult released Sarin into 5 subway cars in downtown Tokyo,12 deaths,hundreds injured,5500 sought care 4,600 self-referred,135 first responders were injured,History of Nerve Agent Weapons Use,Shoko Asahara,NERVE AGENTS,Military,Tabun(GA),Sarin(GB),Soman(GD),VX,Commercial,Parathion,Sevin,Therapeutic Drugs,Antilirium,Prostigmine,Mestinon,General Characteristics,Effects of vapor-immediate,Wide range of symptoms,-Affects sensitive organs of the face and respiratory system,-Over-stimulation of the central nervous system,General Characteristics,ACh,Normal Nerve Function,ACh,AChE,Normal Nerve Function,AChE,ACh,GB,Nerve Agent Action,SLUGBAM:,S,alivation,L,acrimation,U,rination,G,I distress(Nausea,Vomiting,Diarrhea),B,ronchorrhea(Bradycardia,Bronchospasm),A,bdominal cramps,M,iosis,Signs and SymptomsMuscarinic Effects,How Bad Is This Stuff?,VX LD50,System,Effect,Skeletal muscles,Twitching,Weakness,Flaccidity,Cardiovascular,HR,Blood Pressure,CNS,LOC,Seizures,Signs and Symptoms,Nicotinic Effects,Exposure,Symptom,Very small drop,Sweating,Local twitch,Small drop,Nausea,Vomiting,Diarrhea,Drop,LOC,Convulsions,Apnea,Flaccid paralysis,Signs and Symptoms,Dermal Exposure Effects,Exposure,Symptom,Small amount,Miosis,SLUGBAM,SOB,Chest tightness,Large amount,LOC,Convulsions,Paralysis,Death,Signs and Symptoms,Vapor Exposure Effects,3,6,13,20,41,62,Signs and Symptoms,Effect on pupil at x number of days,Clinical picture is key,Erythrocyte acetylcholinesterase activity level,-Amount of inhibition does not correlate with symptoms,Various electronic and“paper detectors are available-for HAZMAT use,Diagnosis,GENERAL PATIENT MANAGEMENT,PPE(,mask,gloves and protective suit),Decontamination,Dont let your setting become contaminated,ABCs,Communicate with public health officials,Poison Control Center(800 222-1222),Antidotes where appropriate,General Management,Soap and Water,Hypochlorite Solution,0.5%for skin,6 oz calcium hypochlorite in 5 gallons water,5.0%for equipment,48 oz calcium hypochlorite in 5 gallons water,Prehospital Management,Adult atropine dose:“enough,Give atropine regardless of heart rate,Pediatric Considerations,0.01mg/kg,Atropine used until endpoint achieved(resolution of secretions),Treatment,Atropine,-Blocks the effects of neurotransmitter,2-PAMCl(Pralidoxime),-,Removes nerve agent from the enzyme,Military Autoinjector,MARK I,Antidote,AChE,2-PAMCl,Nerve Agent,Name,Synonym,Aging T1/2,Sarin,GB,5 hours,Soman,GD,2 min,Tabun,GA,40 hours,VX,None,40 hours,“Aging,Nerve Agent Questions,What was the public health lesson learned from the 1995 Sarin terrorists attack in the subway system of Tokyo,Japan?,This bioterrorist attack could only occur in a large city with an enclosed underground subway system.,The walking wounded and hysterical patients often overload the
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