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

Medical Aspects of Chemical WarfareChemical Corps research, 414, 422–424chemical structure (figure), 739clinical pharmacology, 422–423delirium features, 423–424description and incapacitating effects, 422, 427, 738development of, 3, 59duration of action, 738inhalation studies, 422–423, 427lethal dose, 738mechanism of action, 738–739molecular weight, 738parameter definitions, 423physostigmine treatment for intoxication by, 426, 523placidity and, 425routes of administration, 422safety of, 427stockpiles of, 739summary of BZ and fentanyl derivatives (table), 429tetrahydroaminacridine treatment for intoxication by, 426therapeutic ratio, 427use of by Iraq during the Persian Gulf War, 413weaponization of, 738ThucydidesHistory of the Peloponnesian War, 10, 78TICs. See Toxic industrial chemicalsTIM. See Toxic industrial materialTissue sample analysismustard agent, 726Tobacco use. See SmokingTobramycinmustard agent treatment, 672Tooele Army Depot, UTdemilitarization of chemical agents, 141–142, 143, 157Topical antibiotics. See also Antibioticstreatment of mustard agent exposure, 280, 672Torngren, S.individual protective equipment research, 543–544Torsade de pointesnerve agent exposure and, 179Total-body coolingneuroprotectant use, 232Toxic Chemical Agent Safety Standardsprotection levels for workers, 596Toxic epidermal necrosiscompared with skin injuries from mustard agent, 278, 279Toxic industrial chemicals. See also Toxic industrial material;specific agentscommon sources, 340definitions of airborne toxic material (table), 340description, 340forms of, 340history and use, 341–345inhalational injury from, 340–365mechanism of injury, 340, 355, 356–357mechanisms of toxicity, 345–353military uses, 341nonmilitary uses, 341–345potential for accidental or deliberate exposure, 341respiratory protection equipment, 563triage considerations, 519–520, 522, 523US Army Center for Health Promotion and Prevention Medicinetoxic industrial chemicals (table), 343–344Toxic industrial material. See also Toxic industrial chemicalsdetection and identification, 580–581individual protection, 580respiratory protection equipment, 563use in improvised explosive devices, 580Toxic smokescommon sources, 345early military use, 10–11, 78, 341pathophysiological effects, 350uses for, 134Toxicological studiesnerve agents, 322Toxins. See also specific agentsaccidental exposure, 616biotoxin threat, 616categories of, 614chemical warfare agent comparison, 616–617Chemical Weapons Convention definition, 614delivery methods and use of, 614, 616emergent threats, 617established threats, 616–617food and water supplies and, 616list of known toxins and their sources (table), 615–616nature of the threat from, 614storage capability and use of, 614terrorism and use of, 614, 633Transformational medical technologies initiativedescription, 647Treatment of Chemical Agent Casualties, 184Treatment of incapacitating agent exposure. See also Field managementof chemical casualties; specific agents and drugscardiovascular system, 472eyes, 471laboratory findings, 472respiratory tract, 471–472skin, 471Treatment of mustard agent exposure. See also Field managementof chemical casualties; specific agents and drugsairway injuries, 287–290antimicrobials, 280–281antioxidants, 282biologic dressings, 280bone marrow issues, 288–290, 672burn centers and, 278categories of casualties, 277changing of dressings, 280debridement, 280, 282, 283–285, 290, 670decontamination, 277, 312, 670deep injury treatment, 281, 283depth of injury assessment, 282–283dressings, 280, 282, 285eye injuries, 287fluid and electrolyte monitoring, 278, 279gastrointestinal tract issues, 288, 290goal of blister management, 670growth factors, 285–286hospitalization issues, 262, 277, 281indocyanine green fluorescence imaging, 283Laser Doppler perfusion imaging, 283long-term effects, 291nonsteroidal antiinflammatory drugs, 282off-gassing and, 282, 671pain control, 278, 279pediatric population and, 670–672return to duty guidelines, 290–291secondary infection risk, 281, 288–289skin injuries, 278–287, 670–672skin substitutes, 286–287supportive care, 278topical antibiotics, 280unroofing and cleansing of blisters, 279–280vacuum-assisted closure therapy, 287lxii