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

IndexZyklon B development, 15Cyanide poisoninganalytical methods, 377, 731–734analytical methods to identify cyanide and its metabolites inbiological fluids (table), 378–379antidotal treatment, 383, 518–519, 675–676antidotes useful in acute cyanide poisoning (table), 395biochemical basis, 374–377blood sampling issues, 377, 379–381, 382, 387cardiac toxicity, 391–393case synopses, 388–389change in the electrocardiogram caused by the presence ofcyanide in the tissue (figure), 392clinical presentation and management of casualties, 381–386,518–519, 674, 731computational models of cardiac tissue, 392–393Cyanokit treatment, 676decontamination, 386–387detection of cyanide and cyanide metabolites, 377–381effect of cyanide on a ventricular cell (figure), 392electrocardiogram from a cyanide-intoxicated individual(figure), 392enzyme inhibition, 382–383fire victims and, 390–391, 731fundamentals of cyanide antidote therapy (figure), 385hemodialysis treatment, 383histopathologic changes in cardiac tissue, 391–392laboratory findings, 387, 674lethal dose, 383long-term effects, 387–389metabolic routes, 376, 731methemoglobin former treatment, 394–396mnemonic for recognition of cyanide toxicity (exhibit), 675mortality from, 322, 376, 381, 731mouth-to-mouth resuscitation and, 675multistage antidote kit treatment for managing unconscious,cyanide-exposed patients (table), 675neurological/psychological responses to cyanide and its countermeasures,393–394oxygen therapy, 385patient transport/evacuation, 387pediatric considerations, 389–390, 674–676plot against the US Embassy in Italy, 128polyintoxications, 390–391procedures for collecting and storing blood samples for delayedcyanide analysis (exhibit), 382protection of rescuers, 382schematic diagram of possible detoxification reaction for cyanidein a theoretical cell (figure), 375specific antidotes, 394–397supportive treatment, 323, 383, 674, 675survivability of, 381–382, 388–389symptoms of severe ingestions, 323therapy principles, 381–386thiocyanate and, 380treatment, 674–676triage considerations, 386, 518–519, 521, 522, 5232-aminothiazoline-4-carboxylic acid and, 376US approach to cyanide antidotes (table), 386variation of sodium nitrite and sodium thiosulfate dose withhemoglobin concentration (table), 676wound decontamination and, 538Cyanogen bromideintroduction of, 373Cyanogen chloridedelayed toxic effect, 373discovery of, 116introduction of, 18synthesis of, 116US troop training and, 53World War I use, 373Cyclohexylmethyl phosphonofluoridate. See CyclosarinCyclosarinaging time, 202chemical structure (figure), 694hydrolysis pathway of sarin, soman, and cyclosarin (figure),696Iraq’s production of, 202polyneuropathy and, 317synthesis of, 157toxicity and speed of action, 156, 168, 693treatment of exposure to, 202volatility of, 168Cysteinephosgene exposure and, 736Cytoxansimilarity of mustard agent to, 313DDA PAM 40-8. See Occupational Health Guidelines for the Evaluationand Control of Occupational Exposure to Nerve Agents GA, GB, GD,and VXDA PAM 40-173. See Occupational Health Guidelines for the Evaluationand Control of Occupational Exposure to Mustard Agents H,HD, and HTDA PAM 50-6. See Chemical Accident or Incident Response and AssistanceOperationsDA PAM 385-61. See Toxic Chemical Agent Safety StandardsDAET. See Diisopropyl aminoethanethiolDakin solutiontreatment of mustard agent injuries, 280–281, 671Dantrolenecombined with diazepam, 228dosage considerations, 227soman-induced seizure-related brain damage treatment,227–228Dark, Dr. Eric P.personal account of a chemical attack (exhibit), 102Daturause as an incapacitating agent, 413Davies, D.R.nerve agent research, 317Davy, Sir Humphrysynthesis of phosgene, 116Debridementenzymes and, 284–285lasers and, 284powered dermabrasion, 284treatment of mustard agent injuries, 280, 282, 283–285, 290,670–671wound decontamination and, 539Decontaminable littersdescription and uses, 588–589Decontamination equipmentequipment decontamination, 582–583joint service personnel skin decontamination system, 582M291 skin decontamination kits, 533, 536, 581methods in development, 583–584patient thorough decontamination, 543–546pediatric population and, 661, 678personnel decontamination, 581–582Decontamination of chemical casualtiesaction of chemical agents on the skin, 529–530air heaters and, 550xxxv