Acute Chemical Emergencies
Stefanos N. Kales, M.D., M.P.H., and David C. Christiani, M.D., M.P.H.
Acute chemical emergencies can occur as a result of an industrial disaster,1,2 occupational exposure,3,4 recreational mishap,5 natural catastrophe,6 chemical warfare,7,8 and acts of terrorism.9,10 This article reviews the health effects most commonly associated with the short-term release of industrial and environmental substances and with the use of chemical weapons. We emphasize the application of empirical principles and the recognition of four clinical syndromes, or “toxidromes,” that are applicable to most scenarios of accidental release of chemicals and deliberate release as in acts of chemical terrorism. The classes of substances that correspond to these clinical syndromes are asphyxiants (e.g., cyanide), cholinesterase inhibitors (e.g., organophosphorus nerve agents), respiratory tract irritants (e.g., chlorine), and vesicants (e.g., mustard) (Table 1). The agents that cause each clinical syndrome require similar treatment.
In accidental industrial releases, information about the presence of specific chemicals may be available from the personnel of the facility, safety officials, and other sources. In contrast, an act of terrorism is more likely to involve substances that cannot be immediately identified. Owing to the rapidity of the onset of similar symptoms in a group of persons or the close proximity of a group of persons to a release of hazardous materials, chemical exposures are more quickly recognizable than are exposures to biologic agents.11,12 However, in contrast to the period of latency that is associated with the effects of biologic agents, when serious chemical intoxication occurs, the window for effective therapy is often narrow. Furthermore, real-time identification of specific chemicals by means of environmental or clinical laboratory testing is difficult.13,14 Read the rest of this entry »
Tags: article, emergencie, journal, Medical
Posted in Medical | No Comments »
