Nursing CE - RnCeus.com

Agents & Descriptions	Onset of Symptoms Post Exposure	Signs & Symptoms Routes of Exposure	Action, Risks	Decontamination and Treatment
Nerve Agents:
Sarin Pure liquid is clear, colorless, tasteless … becomes brown with aging	Immediately if inhaled, may be several hours if it touches the skin	Runny nose, watery eyes, drooling, blurred vision, headache, excessive sweating, chest tightness, difficulty breathing, nausea, vomiting, loss of bowel/bladder control, muscle cramps, twitching, confusion, convulsions, paralysis, and coma * Can enter the body by inhalation, ingestion, through the eyes and skin * *	Chemicals that attack the nervous system by binding w/ acetylcholinesterase, allowing acetylcholine to over stimulate the glands and voluntary muscles, until they fail. * Lethal … 1 drop on the skin can cause death in less than 15 minutes	Skin: Remove contaminated clothing (double bag in plastic bags and seal) and wash skin with large amount of soap and water or 5% bleach. Rinse well with water. * Eyes: Immediately flush eyes with water for 10-15 minutes … do NOT cover eyes with patches afterwards. Ingestion: Do NOT induce vomiting. If patient alert and able to swallow, immediately administer activated charcoal * Vapor: Remove outer clothing and place in sealed double bag. Care for exposed skin as above. * Emergency Treatment & Antidotes: Maintain airway, cardiac monitor, IVs, monitor vital signs. Follow ACLS protocols. Administer Atropine (2 mg for adults, 0.05 - .1 mg/kg for children) q 5-10 minutes until respiratory status stabilizes; antidote (2-PAM CL), and diazepam for seizures (barbiturates and phenytoin are not effective)
VX Amber colored, tasteless, and odorless oily liquid	Onset of symptoms vary based on route of exposure * VX absorbs very rapidly through the eyes * At least 100 times more toxic than Sarin when enter through the skin and twice as toxic by inhalation .	* Runny nose, watery eyes, drooling, excessive sweating, chest tightness, dyspnea, pinpoint pupils, nausea, vomiting, abdominal cramps, incontinence of bowel or bladder, twitching, headache, confusion, coma, or seizures * Can enter the body by inhalation, ingestion, through the eyes and skin * Death can occur w/i 15 minutes of absorption of fatal dosage	Kills by binding acetylcholinesterase. This causes constant stimulation of glands and voluntary muscles until ultimate fatigue and a cessation of breathing ability * Extremely lethal and persistent … can last for months in cold weather, evaporates 1,500 times slower than water	Skin: Remove contaminated cloths and wash skin with large amounts of soap and water, 10% sodium carbonate, or 5% liquid household bleach. Rinse well with water. Administer antidote only if local sweating and muscular twitching is present. * Eyes: Immediately flush eyes with water for 10-15 minutes, then place respiratory protective mask. Use antidote only if more symptoms than just miosis occur. VX absorbs 100 times faster through the eyes than Sarin does. * Ingestion: Do NOT induce vomiting. * Inhalation: Use positive pressure full face breathing mask. Do NOT perform mouth-to-mouth on a patient with VX exposure! Immediately administer nerve agent antidote. * Emergency Treatment & Antidotes: Maintain airway, cardiac monitor, IVs, monitor vital signs. Follow ACLS protocols. Administer Atropine (2 mg for adults, 0.05 - .1 mg/kg for children) q 5-10 minutes until respiratory status stabilizes; antidote (2-PAM CL), & diazepam for seizures (barbiturates & phenytoin are not effective)
GF Cyclohexyl Sarin Colorless and odorless liquid in pure form	Depending on the dose, onset of symptoms occur within minutes or hours * Rapid absorption through the eyes	* Runny nose, miosis, headache, dyspnea, chest tightness, cough, drooling, excessive sweating, copious sinus secretions, nausea, vomiting, abdominal cramps, diarrhea, incontinence of bowel and bladder, muscle twitching and weakness, confusion, apnea, coma, death * Can enter the body by inhalation, ingestion, through the eyes and skin	Organophosphorus compound, a lethal cholinesterase inhibitor similar in action to Sarin	Skin: Remove contaminated cloths and wash skin with large amounts of soap and water, 10% sodium carbonate, or 5% liquid household bleach. Rinse well with water. Administer antidote only if local sweating and muscular twitching is present. * Eyes: Immediately flush eyes with water for 10-15 minutes, then place respiratory protective mask. Only use antidote if more symptoms than just miosis occur. * Ingestion: Do NOT induce vomiting. Immediately administer nerve agent antidote * Inhalation: Use positive pressure full face, self-contained breathing apparatus. For severe signs, immediately administer nerve agent antidote and oxygen. Do NOT perform mouth-to-mouth resuscitation if face is contaminated with GF * Emergency Treatment & Antidotes: Maintain airway, cardiac monitor, IVs, monitor vital signs. Follow ACLS protocols. Administer Atropine (2 mg for adults, 0.05 - .1 mg/kg for children) q 5-10 minutes until respiratory status stabilizes; antidote (2-PAM CL), & diazepam for seizures (barbiturates & phenytoin are not effective)
Pulmonary Agents:
Nitrogen Oxide Red/brown gas or a yellow liquid with pungent odor	The substance and vapor irritate the eyes, skin, and respiratory tract. * Effects may be delayed	Cough, wheezing, sore throat, dizziness, headache, sweating, dyspnea, vomiting, or redness at point of contact (eyes, skin) * Can enter the body by inhalation or ingestion.	Causes lung edema * Exposure of high amounts can cause death	Skin: Rinse with plenty of water then remove contaminated clothing and rinse again. Refer for medical attention * Eyes: Flush eyes with water for 10-15 minutes (be sure to remove contact lenses), then refer for medical attention. * Ingestion: Rinse mouth with copious amounts of water * Inhalation: Apply oxygen, place in sitting position. Seek medical evaluation.
Chlorine Green/yellow gas with pungent odor	Effects may be delayed	Very corrosive effects * Tearing of the eyes, headache, sore throat, cough, dyspnea, burning sensation, lung edema, frostbite, burns to the skin, nausea, eye pain, blurred vision, * Enters the body by inhalation.	Corrosive effects to lungs, skin, and eyes * Chronic exposure results in erosion of the teeth, chronic bronchitis. * Over exposure can cause death *	Skin: Remove contaminated clothing then rinse skin with plenty of water or a shower. Seek medical help for burns. * Eyes: Flush eyes with water for 10-15 minutes (be sure to remove contact lenses), then refer for medical attention. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Seek medical evaluation.
Sulphur Dioxide Colorless gas or compressed liquefied gas with pungent odor	Inhalation symptoms may be delayed * Contact with skin can cause immediate frostbite	Frostbite to the skin, eye pain with redness and severe burns, sore throat, cough, dyspnea, lung edema, reflex spasm of the larynx, respiratory arrest, death. * Enters the body by inhalation.	Strong irritant to the eyes and respiratory tract * Repeated or prolonged exposure can cause asthma	Skin: Remove contaminated clothing then rinse with plenty of water. Do NOT remove clean clothing. Seek medical help for frostbite. * Eyes: Flush eyes with water for 10-15 minutes (be sure to remove contact lenses), then refer for medical attention. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Seek medical evaluation.
Phosgene Colorless gas. Colorless to yellow compressed liquefied gas with characteristic odor.	Inhalation symptoms may be delayed * Contact w/ skin can cause immediate frostbite	Frostbite to the skin, eye pain with redness and severe burns, blurred vision, sore throat, cough, dyspnea, lung edema, death. * Enters the body by inhalation.	Corrosive to skin, respiratory tract, and eyes * Long-term exposure may result in lung fibrosis.	Skin: Remove contaminated clothing then rinse with plenty of water. Do NOT remove clean clothing. Seek medical help for frostbite. * Eyes: Flush eyes with water for 10-15 minutes (be sure to remove contact lenses), then refer for medical attention. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Seek medical evaluation.
Titanium Tetrachloride Colorless to light yellow liquid with pungent odor	Symptoms may be delayed	Red painful eyes with burns, skin blisters, cough, dyspnea, chest tightness, abdominal pain, shock, coma * Enters the body by inhalation or ingestion	Corrosive to skin, eyes, respiratory and GI tract. Can cause permanent eye damage. * Long-term exposure may result in lung impairment.	Skin: Remove contaminated clothing, rinse w/ plenty of water, then wash with soap and water * Eyes: Flush eyes with water for 10-15 minutes (be sure to remove contact lenses), then refer for medical attention. * Ingestion: Rinse mouth. Do NOT induce vomiting. Seek medical attention immediately * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Seek medical evaluation.
Blister Agents
Lewisite Amber to dark brown liquid & has a strong penetrating geranium odor. The pure compound is a colorless, odorless, oily liquid	Immediate symptoms with eye exposure, inhalation, or ingestion * Skin contact produces symptoms within 30 minutes.	Eyelid swelling, severe eye pain, iritis, copious sinus drainage, violent sneezing, cough, frothing mucous, lung edema, large skin blisters and burns, diarrhea, hypothermia, hypotension * Severe irritation and lung edema. Can cause systemic poisoning, hemo-concentration, shock, & death. * Can enter the body by inhalation, ingestion, through the eyes and skin	Causes blindness w/i 1 minute of exposure * Nonfatal hemolysis results in anemia. * Metabolites excreted by liver cause focal necrosis of liver, biliary passages, and intestine. * Long term exposure can cause chronic lung impairment and cancer	Skin: Immediately wash skin and clothes with 5% sodium hypochlorite or household bleach within 1 minute of exposure then cut and remove contaminated cloth. Rewash skin again with 5% liquid household bleach. Then wash contaminated skin a 3rd time with soap and water. * Eyes: Immediately flush eyes with water for 10-15 minutes. * Ingestion: Rinse mouth. Do NOT induce vomiting. Give patient milk to drink. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Do NOT perform mouth-to-mouth if facial contamination has occurred.
Mustard Gas Pure liquid is colorless & odorless. Agent grade material is yellow, brown, or black with a sweet type odor of garlic or horseradish	Rapid penetration of moist mucous membranes and skin. * Delayed severe symptoms of the respiratory tract.	Severe tearing and pain of eyes with possible blindness, sneezing, coughing, anorexia, diarrhea, fever, skin blisters * Can enter the body by inhalation, ingestion, through the eyes and skin. Tender skin, mucous membranes, and perspiration covered skin is more vulnerable.	Causes delayed severe damage to the respiratory tract and cytotoxic action on hematopoietic tissues. * Lethal doses are carcinogens and teratogenics. * Distilled mustard is nearly pure, while mustard gas is only 70% - 80% pure	Skin: Immediately wash skin and clothes with 5% sodium hypochlorite or household bleach within 1 minute of exposure then cut and remove contaminated cloth. Flush skin again with 5% sodium hypochlorite solution, then wash contaminated skin a 3rd time with soap and water. * Eyes: Immediately flush eyes with water for 10-15 minutes. Do not cover with bandages. Use dark goggles or glasses. * Ingestion: Do NOT induce vomiting. Give patient milk to drink. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Do NOT perform mouth-to-mouth if facial contamination has occurred.
Blood Agents:
Arsine Colorless compressed liquefied gas with a characteristic odor.	Immediate to delayed symptoms, depending on exposure	Causes immediate frostbite when contact made with eyes or skin * Headache, confusion, dizziness, nausea, vomiting, abdominal pain, dyspnea, lung edema, kidney failure, damage to blood cells, death. * Enters the body by inhalation.	Chronic exposure is carcinogenic to humans.	Skin: Remove contaminated clothing then rinse with plenty of water. Do NOT remove clean clothing. Seek medical help for frostbite. * Eyes: Flush eyes with water for 10-15 minutes followed by an immediate eye exam. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation
Cyanogen Chloride Colorless compressed liquefied gas with a pungent odor.	Effects of exposure may be delayed	Causes immediate frostbite when contact made with eyes or skin * Sore throat, severe tearing, confusion, drowsiness, unconsciousness, nausea, vomiting, lung edema * Enters the body by inhalation or absorbed through the skin * Over exposure results in death	Over exposure results in death	Skin: Remove contaminated clothing then rinse with plenty of water. Do NOT remove clean clothing. Seek medical help for frostbite. * Eyes: Flush eyes with water for 10-15 minutes followed by an immediate eye exam. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation.
Hydrogen Chloride Colorless compressed liquefied gas with a pungent odor	Highly corrosive symptoms may begin immediately or be delayed	Corrosive, deep, severe burns to eyes and skin. * Sore throat, blurred vision, coughing, dyspnea, lung edema, burning sensation. * Enters the body through inhalation	Long term exposure may cause erosion to the teeth or chronic bronchitis	Skin: Remove contaminated clothing then rinse with plenty of water. Seek treatment for burns. * Eyes: Flush eyes with water for 10-15 minutes followed by an immediate eye exam. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation.
Hydrogen Cyanide Colorless gas or liquid with a characteristic odor.	Highly irritating … symptoms may be immediate or delayed	Headache, confusion, drowsiness, dyspnea, loss of consciousness, nausea, skin and eye redness and pain, burning sensation * Enters the body through inhalation, ingestion, eye and skin absorption * Easily absorbed as a vapor or through the skin or eyes.	May injure central nervous system, respiratory, and circulatory systems * Exposure may cause death	Skin: Flush skin with plenty of water or take a shower. Wear gloves when administering first aid. * Eyes: Immediately flush eyes with water for 10-15 minutes then seek eye exam. * Ingestion: Rinse mouth immediately. Do NOT induce vomiting. * Inhalation: Apply oxygen, place in sitting position. May need artificial ventilation. Avoid mouth-to-mouth resuscitation.