Blood agents

-blood or tissue agents are chemicals that affect the body by being absorbed into and distributed by the
blood to the tissues. Substances includes arsine, carbon monoxide, cyanide agents, and sodium
monofluoroacetate.

 Arsine- formed when arsenic comes in contact with an acid. It is colorless, nonirritating toxic gas
with mild garlic odor. It is most used in the semiconductor and metals refining industries.
Inhalation is the primary route of exposure, causing red blood cells lysis and symptoms including
weakness, shortness of breath, possible loss of consciousness, respiratory failure, paralysis, and
death. If initial exposure is survived,, long term effects may include kidney damage, neuropathy,
and neuropsychological symptoms.

Initial treatment: fresh air, removal of contaminated clothing, washing contaminated skin and
symptomatic and supportive care. There is no specific antidote for treatment of arsine poisoning.
Patients may need blood transfusions to replace damaged red blood cells.

 Carbon monoxide- Odorless and colorless

 Cyanides- colorless or pale-blue and of bitter almond odor

Recognizing Tissue (Blood) Agents

Forms of cyanides in chemical weapons:

1. cyanogens chloride (CK)

2. hydrogen cyanide (AC)
3. potassium cyanide (KCN)
4. sodium cyanide (NaCN)
 this all maybe released as a liquid, aerosol, or gas for inhalation
 may also be ingested or absorbed through the eyes and skin

Sources of Exposure:

 fumigants(rodenticides and insecticides)

 military poison gas
 fire-by products
 gold and silver ore extrication
 mining, electroplating and steel production

cyanide anion, NC—delivered whether in hydrocyanic acid or in a cyanogens or in a cyanide chloride,

exerts its toxicity by inhabiting mitochondrial cytochrome oxidase, leading to lactic acidosis, hypoxa,
syncope, seizures, dysrhythmias, respiratory failure, and death within minutes after inhalation or
ingestion of a sizable dose.

Three main laboratory findings iondicativ of cyanide exposure:

  an elevated blood cyanide concentration(The most definitive)
 metabolic acidosis with a high concentration of lactic acid
 Oxygen content of the venous blood greater than normal (although it is not specific to cyanide
exposure.

Patient assessment

Cyanide poisoning

Latency period- ten to fifteen seconds

 The signs and symptoms of mild cyanide poisoning are non specific and maybe difficult to
differentiate from other chemical warfare agents.
 The signs and symptoms of moderate to severe cyanide poisoning are profound and may appear
similar to those of the nerve agents.

Arsine/phosphine poisoning

-upon inhalation there maybe a burning sensation in the chest followed by chest pain but there maybe
no symptoms at all, leaving the patient unaware that he/ she has been exposed. Symptoms of shortness
and weakness that is due to sudden severe anemia may occur.

- Initial symptoms include nausea, vomiting, headache, malaise, weakness, dizziness, abdominal pain,
dyspnea and occasionally, red stained conjunctivae. It progress to hematuria, jaundice, and possibly
renal failure. Slight odor of garlic maybe detectable on the breath. Urine may appear bloody and
patients may experience numbness, tinling, burning and pricking, memory ,loss, and disorientation.
Severe anemia, low blood presuure and an elevated serum potassium may be brought about by
hemolysis 2 to 24 hours after exposure. Later look for enlargement of the liver, yellowing o9f the skin
and whites of the eyes or a bronze appearance to the skin.

-two to three weeks after exposure to arsine Mee’s lines (horizontal to the lines of the nails) maybe
observed.

Clinical Diagnostic Tests

 CBC
 Blood glucose
 Electrolyte determinations
 Urine for hemoglobinuria

Treatment

 Proper circulartory and respiratory support until the antidote can be administered
 Pulmonary/ choking agents

 Chemicals that cause severe irritation or swelling of the respiratory tract causing pulmonary
damage and ultimately impairing oxygen delivery.

Substances:
 Ammonia
 Bromine
 Chlorine
 Hydrogen chloride
 Methyl bromide
 Methyl isocynate
 Osmium tetroxide
 Phosgene
 Phosphine
 Phosphorous (elemental, white or yellow)

Riot Control Agents

 Chemical compounds that temporarily inhibit a person’s ability to function by causing irritation
to the eyes, mouth, throat, lungs, and skin. It is present both in solid and liquid form and can be
released in the air as fine droplets or particles

Three major agents

1. Chloroacetophenone (CN) also known as mace
2. Chlorobenzylidenemalononitrile (CS)
3. Diphenylaminearsine (DM)

Duration: 15 to 30 minutes after the exposure ends. Death can immediate when serious chemical burns
are present in the throat and lungs

Patient assessment: Riot Control Agents primarily affecvt the eyes, causing temporary blindness that is
due to lacrimation and blepharospasm.

Radiological Incidents and Emergencies

Types of Radiation

 Alpha- emitted by heavy atoms, such as uranium, radium, radon and plutonium. This radiation
causes a great deal of damage to the living cells it encounters. If inhaled or swallowed, or
introduced into open wounds, alpha can be very damaging.
  Beta- gives radiation dose only to skin, unless they are ingested or inhaled or enters the body
through the open cut wounds.
 Gamma- penetrate the whole body so it delivered radiation doses to internal organs as well as
to the skin

Units of radiation dose

Two kinds of damage:

 The energy is deposited in cells, breaking chemical bonds and interfering with the cells
ability to function properly or even killing the cells.
 Damage of DNA cells ultimately leading to cancer years or decades later.

Health Radiation Exposure

Types:

1. Acute
2. Chronic

Modes:

1. Radiation
2. Radioactive contamination

Radiological Control Methods

Patient decontamination

1. Remove patient’s clothing; dress in hospital scrubs or patient’s gown

2. Rinse contaminated areas with saline solution or deionized water.
3. Shower o r bathe patient, using mild soap and cool-to-warm water.
4. Give sponge bath; discard sponge or washcloth as radioactive waste.
5. Flush open wounds with saline solution or deionized water.
6. Use standard sterilization practices prior to administering injections, suturing, or other practices
that puncture or break the skin.

Emergency Room Contaminated Control

1. Wrap patient in blankets to contain contamination and reduce contamination of facilities

2. Establish dedicated routes for transporting contaminated patients
3. Establish dedicated rooms for decontamination and care for contaminated patients
4. Line dedicated routes and rooms with plastic to reduce contamination of fixed surfaces
5. Do not use rooms for not contaminated patients until checked and released by Radiation safety
Personnel
Medical Staff Contamination Control

1. Follow universal precautions- wear gloves, lab coats, shoe covers, and so forth , to reduce
personnel contamination and to cover all exposed skin to maximum extent possible.
2. Wear surgical mask to rteduce chance of contamination inhalation.
3. Securely bandage or cover all open cuts, scrapes, and other wounds
4. Change gloves after each patients
5. Remove shoe covers prior to leaving any contaminated area
6. Wash hands and exposed skin thoroughly after each patient
7. Change clothes and shower at the end of the shift or when leaving patient decontamination or
treatment areas.
8. Medical personnel working with highly contaminated patents should consider performing a
urine bioassay 24 to 72 hours after exposure to check for evidence of radionuclide uptake.
About 20 mL of urine is required , of which 1 mL. will be counted in a liquid scintillation counter

Emergency care for Badly injured, contaminated patients

1. If the patients requires immediate attention, treat the patient first and worry about the
radiological controls when the patient’s condition has stabilized later.
2. Even badly contaminated patients pose no health risk to medical or emergency personnel

Responsibilities of Radiation safety Personnel, If present

1. Survey patients prior to their entry into medical facilities

2. Assist with patient decontamination when practicable
3. Assist establishing controlled areas for patient transport and treatment
4. Survey controlled areas periodically to determine necessity for replacing or renewing coverings.