Nerve agents may be delivered in vapor, droplet, or a combination of both forms. The accumulation of acetylcholine at the endings of the motor nerves to voluntary muscles and the autonomic ganglia results in nicotinic-like signs and symptoms. A summary of organophosphate-induced muscarinic and nicotinic symptoms is shown in Table 1. 13. 46. One such poison proposed for military use is fluoroacetic acid, which inhibits the tricarboxylic acid cycle. Cartridge respirators have a finite lifetime of use. Any artillery or mortar capable of delivering a chemical munition is suitable. Clinical toxicology of cyanide. Weger NP. The inhibition of cholinesterase enzymes is irreversible unless rapidly reactivated by an appropriate oxime, so effects are prolonged.

Laboratory examination shows a picture of hemolytic anemia with elevated plasma hemoglobins and hemoglobinuria.

Methemoglobin and carboxyhemoglobin easily are measured. 33. The vapor pressures of the "G" agents make them significant inhalation hazards in any warm climate or with droplet aerosols. Pralidoxime rapidly is excreted in the urine, and the patient should have adequate hydration during therapy. Two other types of chemicals also are transported across country and stored in bulk.

Oxford; New York: Oxford University Press. The toxidrome of abdominal pain, hematuria, and jaundice is characteristic of arsine poisoning, though many patients will not have all three signs. Also, partial presentations (an absence of some of the following signs/symptoms) do not necessarily imply less severe disease. In enclosed areas, fire extinguishers spraying Cyanide poisoning can be treated with antidotes; see the The information in the following table, which lists blood agents of military significance,The most significant practical application of blood agents was the use of Longerich, Peter (2010). Other common effects and complications include hypoxia, ischemia, acidosis, hyperthermia, hypothermia, peripheral neuropathy, and cerebral edema. These acute symptoms are followed in 4-6 hours by hematuria. If the garment has exceeded the storage time or the exposure time, there is an increasing chance that the garment will fail. Depending on the causes of your anemia, you might have no symptoms. The level D usually consists of a long-sleeved shirt and long pants, so scrubs do not qualify as even level D protection. Currently, the U.S. Army uses pralidoxime chloride to reactivate cholinesterase. Blood agents are poisons that affect the body by being absorbed into the blood. Finally, release of the vapor or droplets from pressurized containers in aerosol forms can be accomplished. This agent actually causes significant hemolysis and subsequent kidney damage. It is a relatively persistent agent and lasts between two and six days in soil. Nerve agent vapors are heavier than air and tend to sink into low places (for example, trenches or basements). Weber LW, Zesch A, Rozman K. Decontamination of human skin exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in vitro. 8.

Signs and symptoms are not listed in order of presentation or specificity. There is excellent experience with the use of atropine for other disorders and as a preoperative medication. By inhalation, VX is about twice as toxic as sarin. Contaminated clothing must be removed and the skin washed. Arsine (SA) Carbon Monoxide; Cyanide.
Blood Agent Symptoms. 26.

Since bleach generally is recognized as a safe substance, and even ingestions of small amounts of household bleach are considered innocuous, the author believes that 3% [household strength] hypochlorite solution is an acceptable decontamination solution.

The fit of either type of mask is much less critical than with a cartridge respirator, since air is supplied to the user under pressure and leakage will be away from the airway. 21. An act of terrorism with sarin would leave little or no property damage and minimal clean-up costs. Nerve agents irreversibly inhibit acetylcholinesterase. In: Davis JC, Hunt TK, eds. As a product of combustion, CN commonly is mixed with isocyanates, which are intense respiratory irritants. VX may be a much more attractive agent for the terrorist than sarin for several reasons. Signs and symptoms may occur immediately or up to 48 hours after exposure:

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