Medical Aspects of Chemical Warfare (2008) - The Black Vault

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Nerve Agentstivity of smooth muscles with bronchoconstriction, andCNS changes, including seizure activity and apnea.Therapy is based on the administration of atropine,which interferes with receptor binding of ACh at muscarinicbut not nicotinic receptors, the oxime 2-PAM Cl,which breaks the agent-enzyme bond formed by mostagents, and anticonvulsant treatment with diazepamor other benzodiazepines in cases of severe poisoning.Assisted ventilation and other supportive measuresare also required in severe poisoning.For proper protection, it may be necessary to pretreatthose at high risk of exposure to a rapidly agingnerve agent, such as soman, with pyridostigmine, acarbamate that reversibly binds a fraction of the body ’ sChE. This medication now carries FDA approvalagainst soman only.REFERENCES1. Koelle GB. Anticholinesterase agents. In: Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics. 5thed. New York, NY: Macmillan; 1975: 445.2. Davis W. The Serpent and the Rainbow. New York: Warner Books Inc; 1985: 36–37.3. Fraser TR. On the characters, actions, and therapeutic use of the ordeal bean of Calabar. Edinb Med J. 1863;9:124–132.4. Holmstedt B. Structure–activity relationships of the organophosphorus anticholinesterase agents. In: Koelle GB, ed.Cholinesterases and Anticholinesterase Agents. Berlin, Germany: Springer Verlag; 1963: 429.5. Harris R, Paxman J. A Higher Form of Killing. New York, NY: Hill and Wang; 1982: 53.6. Robinson JP. The rise of CB weapons. Vol 1. In: Stockholm International Peace Research Institute, ed. The Problem ofChemical and Biological Warfare. New York, NY: Humanities Press; 1971: 71.7. Koelle GB. Organophosphate poisoning—an overview. Fundam Appl Toxicol. 1981;1:129–134.8. Wilson Kenneth W. Research chemist, Directorate of Medical Research, Edgewood Arsenal, Md. Personal communication,interview, and lectures, 1976.9. Wills JH, DeArmon IA. A Statistical Study of the Adamek Report. Army Chemical Center, Md: Medical Laboratories;1954. Medical Laboratory Special Report 54.10. Program Executive Officer, Program Manager for Chemical Demilitarization. Chemical Stockpile Disposal Program:Final Programmatic Environmental Impact Statement. Aberdeen Proving Ground, Md: Program Manager for ChemicalDemilitarization; January 1988. Publication A3, vol 3.11. Smith RJ. Army poison gas stockpile raises worries in Kentucky. Washington Post. January 22, 1989:A1.12. Newmark J. The birth of nerve agent warfare: lessons from Syed Abbas Foroutan. Neurology. 2004;62:1590–1596.13. Newark J. Neurologist, Washington, DC. Personal examination of one patient, 2005.14. Koelle GB. Anticholinesterase agents. In: Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics. 4thed. New York, NY: Macmillan; 1970: 446.15. Taylor P. Anticholinesterase agents. In: Goodman LS, Gilman A, Hardman JG, Limbird LE, Gilman AG, eds. Goodmanand Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001: 175–191.16. Koelle GB. Protection of cholinesterase against irreversible inactivation by di-isopropyl fluorophosphate in vitro. JPharmacol Exp Ther. 1946;88:232–237.17. Koster R. Synergisms and antagonisms between physostigmine and di-isopropyl fluorophosphate in cats. J PharmacolExp Ther. 1946;88:39–46.205
Medical Aspects of Chemical Warfare18. Freedman AM, Willis A, Himwich HE. Correlation between signs of toxicity and cholinesterase level of brain andblood during recovery from di-isopropyl fluorophosphate (DFP) poisoning. Am J Physiol. 1948;157:80–87.19. Oberst FW, Christensen MK. Regeneration of erythrocyte and brain cholinesterase activity in rats after sublethalexposures to GB vapor. J Pharmacol Exp Ther. 1956;116:216–219.20. Sidell FR. Soman and sarin: clinical manifestations and treatment of accidental poisoning by organophosphates. ClinToxicol. 1974;7:1–17.21. US Department of the Army, Office of the Assistant Secretary of the Army for Installations and Environment. ImplementationGuidance Policy for Revised Airborne Exposure Limits for GB, GA, GF, VX, H, HD, or HT. Washington, DC: DA;June 2004.22. Hayes WJ. Organic phosphorus pesticides. In: Hayes WJ, ed. Pesticides Studied in Man. Baltimore, Md: Williams &Wilkins; 1982: 284–435.23. Adler M, Filbert MG. Role of butyrylcholinesterase in canine tracheal smooth muscle function. FEBS Lett. 1990;267:107–110.24. Kent KM, Epstein SE, Cooper T, Jacobowitz DM. Cholinergic innervation of the canine and human ventricular conductingsystem. Anatomic and electrophysiologic correlations. Circulation. 1974:50:948–955.25. Slavikova J, Vlk J, Hlavickova V. Acetylcholinesterase and butyrylcholinesterase activity in the atria of the heart ofadult albino rats. Physiol Bohemoslov. 1982;31:407–414.26. Kalow W, Genest K. A method for the detection of atypical forms of human serum cholinesterase; determination ofdibucaine numbers. Can J Biochem Physiol. 1957;35:339–346.27. Neitlich HW. Increased plasma cholinesterase activity and succinylcholine resistance: a genetic variant. J Clin Invest.1966;45:380–387.28. Johns RJ. Familial reduction in red cell cholinesterase. N Engl J Med. 1962;267:1344–1348.29. Wetstone HJ, LaMotta RV. The clinical stability of serum cholinesterase activity. Clin Chem. 1965;11:653–663.30. Sidell FR, Kaminskis A. Temporal intrapersonal physiological variability of cholinesterase activity in human plasmaand erythrocytes. Clin Chem. 1975;21:1961–1963.31. Shanor SP, van Hees GR, Baart N, Erdos EEG, Foldes FF. The influence of age and sex on human plasma and red cellcholinesterase. Am J Med Sci. 1961;242:357–361.32. Sidell FR, Kaminskis A. Influence of age, sex, and oral contraceptives on human blood cholinesterase activity. ClinChem. 1975;21:1393–1395.33. Robertson GS. Serum protein and cholinesterase changes in association with contraceptive pills. Lancet. 1967;1:232–235.34. Whittaker M, Charlier AR, Ramaswamy S. Changes in plasma cholinesterase isoenzyme due to oral contraceptives. JReprod Fertil. 1971;26:373–375.35. Callaway S, Davies DR, Rutland JP. Blood cholinesterase levels and range of personal variation in a healthy adultpopulation. Br Med J. 1951;2:812–816.36. Augustinsson K. The normal variation of human blood cholinesterase activity. Acta Physiol Scand. 1955;35:40–52.37. Ketchum JS, Sidell FR, Crowell EB Jr, Aghajanian GK, Hayes AH Jr. Atropine, scopolamine, and ditran: comparativepharmacology and antagonists in man. Psychopharmacologia.1973;28:121–145.206
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The Coat of Arms1818Medical Departm
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Textbooks of Military MedicinePubli
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MEDICAL ASPECTS o fCHEMICAL WARFARE
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ContentsContributorsForeword by The
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ContributorsMICHAEL ADLER, PhDResea
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DONALD M. MAXWELL, MSResearch Chemi
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ForewordThe US military has been co
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PrefaceA significant concern for th
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PrologueThe original edition of Med
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xxii
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Medical Aspects of Chemical Warfare
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Page 178 and 179: Nerve AgentsChapter 5NERVE AGENTSFR
Page 180 and 181: Nerve AgentsAbout 10,000 to 30,000
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Page 190 and 191: Nerve AgentsTABLE 5-3CHEMICAL, PHYS
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Page 198 and 199: Nerve Agentsof jerks and tremor.Cen
Page 200 and 201: Nerve Agentsand they were decreased
Page 202 and 203: Nerve Agentsnerve agent toxicity on
Page 204 and 205: Nerve Agentspatient. Decontaminatio
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Page 214 and 215: Nerve AgentsTABLE 5-7RECOMMENDED TH
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Page 230 and 231: Nerve Agents38. Grob D, Lilienthal
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PROCESSMedical Aspects of Chemical
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Triage of Chemical CasualtiesChapte
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Triage of Chemical Casualtiesreceiv
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Triage of Chemical Casualtiesentran
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Triage of Chemical Casualtiescatego
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Triage of Chemical CasualtiesIn a f
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Triage of Chemical Casualtiesnose)
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Triage of Chemical CasualtiesWith n
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Triage of Chemical Casualties14. Sa
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Decontamination of Chemical Casualt
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• Analyze using GC-MS with methan
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Abbreviations and AcronymsAbBreviat
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Abbreviations and AcronymsPADPRP: p
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