ChemicalRadiologicalPrinciples化学辐射原理.pptx

Chemical/Radiological PrinciplesOBJECTIVESLearn how to perform a rapid assessment of a nerve agent terrorism situation.Recognize characteristic signs and symptoms of nerve agent poisoning.Chemical/Radiological PrinciplesOBJECTIVESUnderstand proper decontamination for nerve agent poisoning.Learn medical management of nerve agent exposed victims.Learn specific antidotes for nerve agent poisoning victims.Chemical/Radiological PrinciplesAn unknown gas is released in the downtown rapid transit station.It is described as a thick mist,and was found in 5 separate stops.Thousands of commuters rapidly fled the stations to the streets.EMS transport is overwhelmed,and several local EDs are unable to absorb the patients presenting by ambulance,car,taxi,and on foot.Many patients present to offices and local health departments.ScenarioFriday,January 31 8:47 AM(Rush Hour)Chemical/Radiological PrinciplesOne patient that presents to a local health clinic complains of tearing and runny nose.He also has mild shortness of breath.Mild wheeze is noted on exam.Ten other patients at the clinicare asymptomatic,but are very worried.ScenarioFriday,January 31 10:02 AMChemical/Radiological PrinciplesPublic health officials confirm that the gas was Sarin,similar to the toxin used in the subway of Tokyo.ScenarioFriday,January 31 10:27 AMChemical/Radiological PrinciplesHas your staff been adequately trained about chemical weapons?Does your staff understand basic principles of decontamination?Who should your staff alert?Who will alert your staff in the event of a chemical terrorism event?Things to ConsiderChemical/Radiological PrinciplesNerve AgentsChemical/Radiological PrinciplesLiquids that disseminate in the vapor/aerosolized formOnset is abrupt(seconds to hours)Designed to irritate,incapacitate,injure or killPredominantly inhalational and dermal threatsIf death occurs,usually respiratory causeCharacteristics of Nerve AgentsChemical/Radiological PrinciplesChemical incidents are obvious shortly after exposure.Biological agents will take days to cause symptoms.ONE patient can contaminate your facilityFirst responders/health care providers are in the line of fireCharacteristics of Nerve AgentsChemical/Radiological PrinciplesFirst used as a weapon during WWIMost recent event-Japanese subway incident in 1995Aum Shinrikyo cult released Sarin into 5 subway cars in downtown Tokyo12 deaths,hundreds injured,5500 sought care 4,600 self-referred135 first responders were injuredHistory of Nerve Agent Weapons UseChemical/Radiological PrinciplesShoko AsaharaChemical/Radiological PrinciplesNERVE AGENTSChemical/Radiological PrinciplesMilitaryTabun(GA),Sarin(GB),Soman(GD),VX CommercialParathion,Sevin Therapeutic DrugsAntiliriumProstigmine Mestinon General CharacteristicsChemical/Radiological PrinciplesEffects of vapor-immediateWide range of symptoms-Affects sensitive organs of the face and respiratory system-Over-stimulation of the central nervous systemGeneral CharacteristicsChemical/Radiological PrinciplesAChNormal Nerve FunctionChemical/Radiological PrinciplesAChAChENormal Nerve FunctionChemical/Radiological PrinciplesAChEAChGBNerve Agent ActionChemical/Radiological PrinciplesSLUGBAM:SalivationLacrimationUrinationGI distress(Nausea,Vomiting,Diarrhea)Bronchorrhea(Bradycardia,Bronchospasm)Abdominal crampsMiosisSigns and SymptomsMuscarinic EffectsChemical/Radiological PrinciplesHow Bad Is This Stuff?VX LD50Chemical/Radiological PrinciplesSystemEffectSkeletal musclesTwitchingWeaknessFlaccidityCardiovascularHRBlood PressureCNSLOC,SeizuresSigns and SymptomsNicotinic EffectsChemical/Radiological PrinciplesExposureSymptomVery small dropSweatingLocal twitchSmall dropNauseaVomitingDiarrheaDropLOCConvulsionsApneaFlaccid paralysisSigns and SymptomsDermal Exposure EffectsChemical/Radiological PrinciplesExposureSymptomSmall amountMiosisSLUGBAMSOBChest tightnessLarge amountLOCConvulsionsParalysisDeathSigns and SymptomsVapor Exposure Effects3613204162Signs and SymptomsEffect on pupil at x number of daysChemical/Radiological PrinciplesClinical picture is keyErythrocyte acetylcholinesterase activity level-Amount of inhibition does not correlate with symptomsVarious electronic and“paper”detectors are available-for HAZMAT useDiagnosisChemical/Radiological PrinciplesGENERAL PATIENT MANAGEMENTChemical/Radiological PrinciplesChemical/Radiological PrinciplesPPE(mask,gloves and protective suit)DecontaminationDont let your setting become contaminatedABCs Communicate with public health officials Poison Control Center(800 222-1222)Antidotes where appropriateGeneral ManagementChemical/Radiological PrinciplesSoap and WaterHypochlorite Solution0.5%for skin6 oz calcium hypochlorite in 5 gallons water5.0%for equipment48 oz calcium hypochlorite in 5 gallons waterPrehospital ManagementChemical/Radiological PrinciplesAdult atropine dose:“enough”Give atropine regardless of heart ratePediatric Considerations0.01mg/kgAtropine used until endpoint achieved(resolution of secretions)TreatmentChemical/Radiological PrinciplesAtropine-Blocks the effects of neurotransmitter2-PAMCl(Pralidoxime)-Removes nerve agent from the enzymeMilitary AutoinjectorMARK IAntidoteAChEAChE2-PAMClNerve AgentNerve AgentChemical/Radiological PrinciplesNameSynonymAging T1/2SarinGB 5 hoursSomanGD2 minTabunGA40 hoursVXNone40 hours“Aging”Chemical/Radiological PrinciplesNerve Agent QuestionsChemical/Radiological PrinciplesWhat was the public health lesson learned from the 1995 Sarin terrorists attack in the subway system of Tokyo,Japan?a.This bioterrorist attack could only occur in a large city with an enclosed underground subway system.b.The walking wounded and hysterical patients often overload the medical system c.Religious cults should be placed under strict federal surveillanced.Ample supplies of the antidotes are readily availableQuestion#1Chemical/Radiological PrinciplesIn the acute phase of poisoning,one of the consistent findings that differentiates Sarin poisoning from hysteria is:a.Cholinesterase enzyme blood levels b.Garlic smell on victims c.Pinpoint pupils d.Tachycardia Question#2Chemical/Radiological PrinciplesBased on past experience,which of the hospital supplies/equipment below is most likely to run out after a mass casualty exposure to Sarin gas?a.Ventilatorsb.Personal Protective Equipment c.Hemodialysis machinesd.Atropine Question#3Chemical/Radiological PrinciplesThis completes the current presentation.