MAJOR INCIDENTAdministrative and Legal Issues 461(g) patients with respiratory depression or impaired
consciousness should receive assisted ventilation and an
intravenous cyanide antidote as soon as possible (see p. 185).
(ii) Nerve agents
(a) highly toxic chemicals which are hazardous by contact to skin
or eyes, inhalation and ingestion
(b) organophosphate compounds can be easily weaponized to
form agents such as sarin, tabun and VX
(c) clinical effects depend on dose, duration and exposure
route, and may be local or systemic, with death occurring
from respiratory arrest due to central nervous system (CNS)
depression and or muscle paralysis
(d) cholinergic effects include diarrhoea, urination, meiosis and
muscle weakness, bronchorrhoea, and bradycardia, emesis,
lacrimation, salivation and sweating (DUMBELS)
(e) rapid decontamination is essential
(f) patients with isolated eye symptoms should be observed for
a minimum of 2 h post exposure, and may be treated with
atropine or tropicamide 0.5% eye drops
(g) treatment for more severely affected patients includes high-
doses of atropine i.v. to dry secretions and increase heart rate,
pralidoxime i.v. and seizure management (see p. 187).
(iii) Vesicants
(a) agents which are irritant and cause blistering of the skin,
eyes and respiratory system. They are hazardous by contact,
inhalation and ingestion, and are rapidly absorbed with
clinical effects that are often delayed by a latent period from
1–24 h
(b) exposure results in gritty, painful eyes with periorbital
oedema, blepharospasm, corneal ulceration and blindness,
which is usually temporary
(c) skin blistering occurs, with hoarseness, cough and dyspnoea
followed by a chemical pneumonitis and acute respiratory
distress syndrome (ARDS)
(d) treatment includes decontamination and supportive care
similar to that of thermal burns.
(iv) Choking or pulmonary agents
(a) agents such as chlorine and phosgene are both irritant,
and corrosive due to dissolving in tissue water to form
hydrochloric acid
(b) skin or eye effects are seen as well as following inhalation,
with individuals with pre-existing lung disease particularly
vulnerable