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

More documents

Recommendations

Info

Long-Term Health Effects of Chemical Threat Agentspostexposure, a particularly severe respiratory symptomcomplex may appear suddenly; exertion seemsto be a prominent precipitating factor. There may besevere cough, dyspnea, and rapid onset of pulmonaryedema. If the patient survives this stage, spontaneousremission occurs within 48 to 72 hours postexposure.More intense exposures produce a relatively rapid onsetof acute bronchiolitis with severe cough, dyspnea,and weakness, without the above-mentioned latentperiod. Again, spontaneous remission occurs at approximately3 to 4 days postexposure. 175Phase 2 is a relatively asymptomatic period lastingapproximately 2 to 5 weeks. A mild residual coughwith malaise and perhaps minimal shortness of breathmay occur, as well as a sense of weakness that mayprogress. The chest radiograph, however, typically isclear. In phase 3, symptoms may recur 3 to 6 weeksafter the initial exposure. Severe cough, fever, chills,dyspnea, and cyanosis may develop. Crackles areidentified on physical examination of the lung. Thepolymorphonuclear white blood cell count is elevated,and the partial pressure of carbon dioxide may be elevatedas well. 176 The chest radiograph demonstratesdiffuse, scattered, fluffy nodules of various sizes,which may become confluent progressively, with abutterfly pulmonary edema pattern and a prominentacinar component. At this point, pathological studydemonstrates classic bronchiolitis fibrosis obliterans,which may clear spontaneously or may progress tosevere, occasionally lethal respiratory failure. Thefluffy nodular changes noted in the chest radiographtypically show no clinical improvement. Pulmonaryfunction testing may show long-term persistence ofairways obstruction. 177–179Zinc OxideHexachloroethane (HC) smoke, a mixture of equalamounts of HC and zinc oxide with additional ingredients,is a toxic military smoke and obscurant. HC’stoxicity is attributed to the irritating effects of zincchloride. Most likely, carbon monoxide, phosgene,hexachloroethane, and other products contribute tothe observed respiratory effects. The damage to thepulmonary system is confined largely to the upperrespiratory tract, where zinc chloride acts much likea corrosive irritant. Studies reveal that HC exposurecan produce a gradual decrease in total lung capacity,vital capacity, and diffusion capacity of carbonmonoxide. HC is associated with the presence ofpulmonary edema, increased airway resistance, anddecreased compliance. When HC smoke exposure isdiscontinued, the pulmonary changes are reversible inall but 10% to 20% of those effected, who could developpulmonary fibrotic changes. 180In a study by Conner et al 181 performed withguinea pigs, exposure to ultrafine HC particles (0.05µm) in increasing degrees was associated with adose-response elevation in protein, neutrophils, andangiotensin-converting enzyme found in lavage fluid.A direct relationship also was observed with alkalinephosphatase, acid phosphatase, and lactate dehydrogenasein lavage fluid. Centriacinar inflammation wasseen histologically, indicating evidence of pulmonarydamage. A study by Marrs et al 182 involving mice, rats,and guinea pigs demonstrated a positive associationof alveologenic carcinoma in a dose-response trendto HC smoke, as well as a variety of inflammatorychanges. The article states that hexachloroethane andzinc, as well as carbon tetrachloride (which may bepresent in HC smoke), may be animal carcinogens incertain circumstances. This raises the suspicion of HCas a potential carcinogen.Metal fume fever is a well-documented acute diseaseinduced by intense inhalation of metal oxides,especially zinc oxide. The exact pathology is not understood,but the clinical syndrome is well describedand has been studied at length. A study by Kuschneret al 183 on human volunteers showed that pulmonarycytokines such as tumor necrosis factor, interleukin6, and interleukin 8 may play important initial rolesin mediating metal fume fever. Prolonged exposuresor exposures to very high doses of HC may resultin sudden early collapse and death, possible as aresult of laryngeal edema or glottal spasm. If severeexposure does not kill the individual immediately,hemorrhagic ulceration of the upper airway may occur,with paroxysmal cough and bloody secretions.Death may occur within hours secondary to an acutetracheobronchitis.Most individuals with HC inhalation injuriesprogress to complete recovery. Of exposed individuals,10% to 20% develop fibrotic pulmonary changes.Distinguishing between those who will recover andthose who will not is difficult, because both groupsmake an early clinical recovery.SUMMARYA wide variety of chemical agents and industrialproducts are associated with long-term health consequencesafter an acute insult. Others are knownto be harmful with prolonged low-level exposure.The linkage between these associations is sometimestenuous given the limitations of retrospective studiesand case reports up to 90 years old. Research laboratoryefforts and future case reports will continue327
Medical Aspects of Chemical Warfareto strengthen the understanding of these effects. Inthe meantime, the existing knowledge base providesclinicians sufficient reason to monitor for these possibleoutcomes and apply proactive surveillanceto individuals working with these chemicals on adaily basis.REFERENCES1. Prentiss AM. Chemicals in War: A Treatise on Chemical Warfare. New York, NY: McGraw-Hill; 1937: 653.2. Robinson JP. The Rise of CB Weapons. Vol 1. In: The Problem of Chemical and Biological Warfare. New York, NY: HumanitiesPress; 1971.3. United Nations Security Council. Report of Specialists Appointed by the Secretary General to Investigate Allegations bythe Islamic Republic of Iran Concerning the Use of Chemical Weapons. New York, NY: United Nations; 1984. UN ReportS/16433.4. Wade JV, Gum RM, Dunn MA. Medical chemical defense in Operations Desert Shield and Desert Storm. J US ArmyMed Dept. 1992;1/2:34–36.5. Sidell FR. The medical management of chemical casualty course in CONUS and Europe during Desert Storm. J USArmy Med Dept. 1992;3/4:10–12.6. Papirmeister B, Feister AJ, Robinson SI, Ford RD. Medical Defense Against Mustard Gas: Toxic Mechanisms and PharmacologicalImplications. Boca Raton, Fla: CRC Press; 1991.7. Sidell FR. Clinical considerations in nerve agent intoxication. In: Somani SM, ed. Chemical Warfare Agents. San Diego,Calif: Academic Press; 1992: 156–194.8. Balali-Mood M, Navaeian A. Clinical and paraclinical findings in 233 patients with sulfur mustard poisoning. In:Proceedings of the 2nd World Congress on New Compounds in Biological and Chemical Warfare: Toxicological Evaluation, IndustrialChemical Disasters, Civil Protection and Treatment, 24–27 August 1986. Ghent, Belgium: International Associationof Forensic Toxicologists; 1986: 464–473.9. Warthin AS, Weller CV. The lesions of the respiratory and gastrointestinal tract produced by mustard gas (dichlorethylsulphide). J Lab Clin Med. 1919;4:229–264.10. Sohrabpour H. Clinical manifestations of chemical agents on Iranian combatants during the Iran–Iraq conflict. In:Heyndrickx A, ed. Proceedings of the 1st World Congress on New Compounds in Biological and Chemical Warfare: ToxicologicalEvaluation, 21–23 May 1984. Ghent, Belgium: State University of Ghent; 1984: 291–297.11. Vedder EB, ed. The Medical Aspects of Chemical Warfare. Baltimore, Md: Williams & Wilkins; 1925.12. Renshaw B. Mechanisms in production of cutaneous injuries by sulfur and nitrogen mustards. In: Chemical WarfareAgents and Related Chemical Problems. Parts 3–6. Washington, DC: Office of Scientific Research and Development, NationalDefense Research Committee, Div 9; 1946: 478–520.13. Reed CI. The minimum concentration of dichlorethylsulphide (mustard gas) effective for the eyes of man. J PharmacolExp Ther. 1920;15:77–80.14. Morgenstern P, Koss FR, Alexander WW. Residual mustard gas bronchitis: effects of prolonged exposure to low concentrationsof mustard gas. Ann Intern Med. 1947;26:27–40.15. Buscher H. Green and Yellow Cross. Conway N, trans. Cincinnati, Ohio: Kettering Laboratory of Applied Physiology,University of Cincinnati; 1944.16. Prokes J, Svovoda V, Hynie I, Proksova M, Keel K. The influence of x-radiation and mustard gas on methionin-35Sincorporation in erythrocytes. Neoplasma. 1968;15:393–398.328
Page 3 and 4:
The Coat of Arms1818Medical Departm
Page 5:
Textbooks of Military MedicinePubli
Page 8 and 9:
MEDICAL ASPECTS o fCHEMICAL WARFARE
Page 10 and 11:
ContentsContributorsForeword by The
Page 12 and 13:
ContributorsMICHAEL ADLER, PhDResea
Page 14 and 15:
DONALD M. MAXWELL, MSResearch Chemi
Page 16 and 17:
ForewordThe US military has been co
Page 18 and 19:
PrefaceA significant concern for th
Page 20:
PrologueThe original edition of Med
Page 23 and 24:
xxii
Page 25 and 26:
Medical Aspects of Chemical Warfare
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 178 and 179:
Nerve AgentsChapter 5NERVE AGENTSFR
Page 180 and 181:
Nerve AgentsAbout 10,000 to 30,000
Page 182 and 183:
Nerve Agentsphorofluoridate (DFP) w
Page 184 and 185:
Nerve AgentsFig. 5-2. This schemati
Page 186 and 187:
Nerve AgentsExhibit 5-1 continuedis
Page 188 and 189:
Nerve Agentsactivity but only 15% t
Page 190 and 191:
Nerve AgentsTABLE 5-3CHEMICAL, PHYS
Page 192 and 193:
Nerve AgentsTABLE 5-4EFFECTS OF EXP
Page 194 and 195:
Nerve Agentsaffecting the other eye
Page 196 and 197:
Nerve Agentsmay cause severe rhinor
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
Page 206 and 207:
Nerve AgentsFig. 5-5. The Mark I ki
Page 208 and 209:
Nerve Agentsadministered intramuscu
Page 210 and 211:
Nerve Agentsthat hydroxamine reacti
Page 212 and 213:
Nerve AgentsOral administration may
Page 214 and 215:
Nerve AgentsTABLE 5-7RECOMMENDED TH
Page 216 and 217:
Nerve Agentsimpairment such as whee
Page 218 and 219:
Nerve Agentssuboptimal, manner. The
Page 220 and 221:
Nerve Agentsthan those who did not.
Page 222 and 223:
Nerve Agentssible for binding nerve
Page 224 and 225:
Nerve Agentsfor comparison was not
Page 226 and 227:
Nerve AgentsTABLE 5-11EFFECTS OF PY
Page 228 and 229:
Nerve Agentstivity of smooth muscle
Page 230 and 231:
Nerve Agents38. Grob D, Lilienthal
Page 232 and 233:
Nerve Agents77. McDonough JH, Shih
Page 234 and 235:
Nerve Agents117. McLeod CG Jr, Sing
Page 236 and 237:
Nerve Agents154. Tryphonas l, Veino
Page 238 and 239:
Nerve Agents193. Funckes AJ. Treatm
Page 240 and 241:
Nerve Agents235. Suzuki T, Morita H
Page 242:
Nerve Agents274. Pellegrini JE, Bak
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300: Medical Aspects of Chemical Warfare
Page 349: Medical Aspects of Chemical Warfare
Page 375 and 376: PROCESSMedical Aspects of Chemical
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469 and 470:
Page 471 and 472:
Page 473 and 474:
Page 475 and 476:
Page 477 and 478:
Page 479 and 480:
Page 481 and 482:
Page 483 and 484:
Page 485 and 486:
Page 487 and 488:
Page 489 and 490:
Page 491 and 492:
Page 493 and 494:
Page 495 and 496:
Page 497 and 498:
Page 499 and 500:
Page 501 and 502:
Page 503 and 504:
Page 505 and 506:
Page 507 and 508:
Page 509 and 510:
Page 511 and 512:
Page 513 and 514:
Page 515 and 516:
Page 517 and 518:
Page 519 and 520:
Page 521 and 522:
Page 523 and 524:
Page 525 and 526:
Page 527 and 528:
Page 529 and 530:
Page 531 and 532:
Page 534 and 535:
Triage of Chemical CasualtiesChapte
Page 536 and 537:
Triage of Chemical Casualtiesreceiv
Page 538 and 539:
Triage of Chemical Casualtiesentran
Page 540 and 541:
Triage of Chemical Casualtiescatego
Page 542 and 543:
Triage of Chemical CasualtiesIn a f
Page 544 and 545:
Triage of Chemical Casualtiesnose)
Page 546 and 547:
Triage of Chemical CasualtiesWith n
Page 548 and 549:
Triage of Chemical Casualties14. Sa
Page 550 and 551:
Decontamination of Chemical Casualt
Page 552 and 553:
Page 554 and 555:
Page 556 and 557:
Page 558 and 559:
Page 560 and 561:
Page 562 and 563:
Page 564 and 565:
Page 566 and 567:
Page 568 and 569:
Page 570 and 571:
Page 572 and 573:
Page 574 and 575:
Page 576 and 577:
Page 578 and 579:
Page 580:
Page 583 and 584:
Page 585 and 586:
Page 587 and 588:
Page 589 and 590:
Page 591 and 592:
Page 593 and 594:
Page 595 and 596:
Page 597 and 598:
Page 599 and 600:
Page 601 and 602:
Page 603 and 604:
Page 605 and 606:
Page 607 and 608:
Page 609 and 610:
Page 611 and 612:
Page 613 and 614:
Page 615 and 616:
Page 617 and 618:
Page 619 and 620:
Page 621 and 622:
Page 623 and 624:
Page 625 and 626:
Page 627 and 628:
Page 629 and 630:
Page 631 and 632:
Page 633 and 634:
Page 635 and 636:
Page 637 and 638:
Page 639 and 640:
Page 641 and 642:
Page 643 and 644:
Page 645 and 646:
Page 647 and 648:
Page 649 and 650:
Page 651 and 652:
Page 653 and 654:
Page 655 and 656:
Page 657 and 658:
Page 659 and 660:
Page 661 and 662:
Page 663 and 664:
Page 665 and 666:
Page 667 and 668:
Page 669 and 670:
Page 671 and 672:
Page 673 and 674:
Page 675 and 676:
Page 677 and 678:
Page 679 and 680:
Page 681 and 682:
Page 683 and 684:
Page 685 and 686:
Page 687 and 688:
Page 689 and 690:
Page 691 and 692:
Page 693 and 694:
Page 695 and 696:
Page 697 and 698:
Page 699 and 700:
Page 701 and 702:
Page 703 and 704:
Page 705 and 706:
Page 707 and 708:
Page 709 and 710:
Page 711 and 712:
Page 713 and 714:
Page 715 and 716:
Page 717 and 718:
Page 719 and 720:
Page 721 and 722:
Page 723 and 724:
Page 725 and 726:
Page 727 and 728:
Page 729 and 730:
Page 731 and 732:
Page 733 and 734:
Page 735 and 736:
Page 737 and 738:
Page 739 and 740:
Page 741 and 742:
Page 743 and 744:
Page 745 and 746:
Page 747 and 748:
• Analyze using GC-MS with methan
Page 749 and 750:
Page 751 and 752:
Page 753 and 754:
Page 755 and 756:
Page 757 and 758:
Page 759 and 760:
Page 761 and 762:
Page 763 and 764:
Page 765 and 766:
Page 767 and 768:
Page 769 and 770:
Page 771 and 772:
Page 773 and 774:
Page 775 and 776:
Page 777 and 778:
Page 779 and 780:
Page 781 and 782:
Page 783 and 784:
Page 785 and 786:
Page 787 and 788:
Page 789 and 790:
Page 791 and 792:
Page 793 and 794:
Page 795 and 796:
Page 798 and 799:
Abbreviations and AcronymsAbBreviat
Page 800:
Abbreviations and AcronymsPADPRP: p
Page 803 and 804:
Page 805 and 806:
Page 807 and 808:
Page 809 and 810:
Page 811 and 812:
Page 813 and 814:
Page 815 and 816:
Page 817 and 818:
Page 819 and 820:
Page 821 and 822:
Page 823 and 824:
Page 825 and 826:
Page 827 and 828:
Page 829 and 830:
Page 831 and 832:
Page 833 and 834:
Page 835 and 836:
Page 837 and 838:
Page 839 and 840:
Page 841 and 842:
Page 843 and 844:
Page 845:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?