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CBRNE - PowerPoint Highlighted Text Flashcards

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1
Q

hellebore roots thrown into water supplying water to enemy troops by soldiers

A

chemical terrorism - hx ex

similar to digoxin - caused cardiac dysarythmias

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2
Q

belladonna plants to cause disorientation in enemy troops

A

chemical terrorism - hx ex

an anticholingergic that turned them into DUMBBBELLS

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3
Q

chlorine gas in trench warfare

A

chemical terrorism - hx ex

chlorine gas is heavier than air and sank into the trenches; above the trench, the solider would be shot

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4
Q

phosgene filled shells fired at french and british forces

A

chemical terrorism - hx ex

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5
Q

saddam hussein orders Ali Hasa al-Majid to use mustard against Iran and Kurds

A

chemical terrorism - hx ex

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6
Q

ISIS has used mustard gas

A

chemical terrorism - hx ex

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7
Q

Novichok nerve agent A-234 to poison Russian officers

A

chemical terrorism - hx ex

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8
Q

Nerve
Blistering (vesicants)
Blood
Choking (pulmonary)

A

type of chemical agents used to kill

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9
Q

Riot-control agents

Psychochemical

A

type of incapacitating chemical agents

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10
Q

How are nerve agents toxic

A

inhibition of AChE at the NMJ

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11
Q

nicotinic cholinergics are…

A

neuromuscular

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12
Q

muscarinic cholinergics are…

A

neuroglandular

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13
Q

Nerve agents are similar to ____ poisoning

A

organophosphate

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14
Q

Most likely nerve agent at risk for human toxicity on a large scale and is very potent

A

organophosphorous esters (organophosphates)

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15
Q

common warfare nerve agents

A

G-agents (sarin, tabun, soman)

V-series (VX)

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16
Q

Nerve agents are prone to ____

A

aging

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17
Q

what’s aging

A

an irreversible bond between an organophosphate and AChE –> permanent stimulation of the receiving neuron

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18
Q

What warfare nerve agent has a particularly rapid aging process

A

soman

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19
Q

clinical manifestations of nerve agents that cause muscarinic effects

A

DUMBBBELLS: diaphoresis, urinary incontinence, miosis, bronchorreha, bronchospasm, bradycardia, emesis, lacrimation, loose stools, salivation

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20
Q

clinical manifestations of nerve agents that cause nicotinic effects

A

MTWHF: mydraisis, tachycardia, weakness, HTN, fasciculations

nervous system based: weakness, HTN, hyperglycemia, local/generalized muscle fasciculations
tachycardia
mydriasis

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21
Q

what are the three killer B’s of muscarinic nerve agents

A

B: bronchorrhea
B: bronchospasms
B: bradycardia

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22
Q

aum shinrikyo

A

nerve agent: sarin gas in 1995

bioterrorism agent: anthrax in 1994 in Tokyo

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23
Q

Death occurs with VX (nerve agent) within _____ and effects are nearly _____ if VX is _____ and is ______

A

Death occurs within an hour or two and effects are nearly instantaneous if VX is gaseous and is inhaled

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24
Q

Medical management of nerve agents

A

ABCDD: airway, breathing, circulation, decontamination, drugs

prevent becoming a casualty yourself

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25
best agent for decontamination
soap and water
26
how do you handle the airway in nerve agents
aggressive airway management including suctioning
27
what agent must you avoid during a nerve agent exposure intubation
succinylcholine: prolongation of normal duration of effect due to current nerve agent exposure having the same effect already
28
antidote for muscarinic nerve agent exposure and MOA
atropine: dries them up!
29
antidote for nicotinic nerve agent exposure and MOA
pralidoxime chloride (2-PAM) to release muscular paralysis (Miosis Tachyardia Weakness HTN Fasciculations)
30
antidote for seizures during nerve agent exposure
BZN: midazolam is fastest acting
31
4 blistering agents that cause skin burns with blistering
nitrogen mustards sulfur mustards lewisite phosgene oxime
32
blistering/vesicants tends to exert most damage on ____
actively proliferating cells such as basal epidermal cells, hematopoietic cells, mucosal lining of intestines
33
what is the dormancy period of blistering agents after exposure
4 - 12 hours however, if more agent exposure, the latency shortens
34
garlic/horseradish odor
sulfur mustard blistering agent
35
mustard, onion, asphalt odor
sulfur mustard blistering agents
36
fishy ordor
nitrogen mustard blistering agents
37
no odor or fruity odor
nitrogen mustard blistering agents
38
string of pearls distribution overlying a normal, but severely damaged skin
mustard blistering agents
39
is mustard blistering agents lethal?
not usually, but serious permanent damage occurs, esp. to eyes
40
geraniums odor
lewisite blistering agent
41
what blistering agent causes immediate pain to exposed areas of the body?
lewisite mustards take 4 - 12 hrs
42
antidote for lewisite
british anti-lewisite (BAL) in peanut oil solution
43
conditions that require systemic tx in lewisite exposures
cough with SOB + frothy sputum (pulmonary edema) skin burn >1% (size of palm) skin contamination with immediate skin damage (dead/gray-white blanching) or erythema
44
when do you decontaminate with blistering agents
1-2 minutes post exposure to prevent further/increasing tissue damage
45
military/terrorist cyanides of interest (2)
hydrogen cyanide | cyanogen chloride
46
blood agents
cyanide agents
47
how do blood agents works
combine with ferric ion and inhibit electron transport chain to convert the body from aerobic metabolism to anaerobic metabolism
48
anaerobic effects of blood agents on the body
lactic acid buildup high anion gap metabolic acidosis progressive tissue hypoxia with potential cellular death
49
most sensitive organs to blood agent toxicities
heart and CNS
50
peach kernels odor
hydrogen cyanide
51
bitter almonds odor
hydrogen cyanide even though 40% of population cannot smell almonds
52
``` clinical manifestations of ____: HA nausea vertigo complete recovery ```
small exposure to hydrogen cyanide
53
``` clinical manifestations of ____: HA nausea vertigo seizures or coma ```
moderate exposure to hydrogen cyanide
54
``` clinical manifestations of ____: rapid and deep breathing violent convulsions cessation of respiration cardiac arrest/death ```
serious exposure to hydrogen cyanide happens in a few minutes
55
burnt fireworks odor
cyanogen chloride
56
pungent biting odor
cyanogen chloride
57
amyl nitirite and sodium nitrite: what does it treat what does it do
TREAT: cyanide poisoning DO: causes methemoglobinemia and binds to the cyanide ion in the electron transport chain to remove it from the chain
58
sodium thiosulfate: what does it treat what does it do
TREAT: cyanide poisoning DO: enhances conversion from cyanide to thiocyanate and binds cyanide irreversibly so that it cannot renter mitochondria/get into ETC; renally excreted
59
hydroxycobalamin: what does it treat what does it do
TREAT: cyanide poisoning DO: reacts with cyanide ion to form cyanocobalamin (B12) and water to be renally excreted
60
how to correct metabolic acidosis of blood agents
sodium bicarb
61
what's the therapeutic approach to treating blood agents
supportive care
62
in comparison to carbon monoxide, what can help with cyanide poisonings
oxygen! can make it easier to kick off the cyanide
63
cyanide and the ETC
cyanide binds to the cytochrome oxidase, uncouples mitochonidral oxidative phosphorylation, inhibits cellular respiration, and induces anaerobic metabolism = lactic acid
64
choking agents (2)
phosgene | chlorine gas
65
least dangerous of the chemical weapons
choking agents: phosgene and chlorine gas
66
newly mown or musty hay odor
phosgene choking agent
67
interesting fact about phosgene
requires refrigeration
68
____ + water = HCl and CO HCl causes epithelial damage, necrosis of bronchial/bronchioalr/capillary membranes
phosgene this is how phosgene is toxic: hydrolysis method = non-cardiogenic pulmonary edema
69
two toxic chemical methods of phosgene
hydrolysis | acylation
70
phosgene reacts with functional groups on proteins, carbohydrates, lipids to cause severe oxidative damage results in depletion of glutathione, increased cytokines, and acute lung injury
acylation toxicity of phosgene
71
upper airway sx of lacrimation, cough, bronchoconstriction lower airway exposure gives acute lung injury
chlorine toxicity
72
chlorine and airway water results in
HCl, hypochlorous acid, oxygen free radicals
73
how does chlorine kill
pulmonary edema
74
riot control agents are AKA
tear gas lacrimators harassing agents
75
oleoresin capsicum
law enforcement pepper spray
76
riot control agents are designed to...
produce a sensory irritation and severe discomfort that is quick onset, short duration, and high safety (non lethal)
77
results of riot control agents are like...
having allergies/SLUDGE
78
how to treat riot agents
supportive, help remove clothes/contact lenses
79
psychochemical agents (5)
``` fentanyl sufentanyl LSD (lysergic acid diethylamide) scopolamine psilocybin ```
80
``` ergot rye plague smallpox anthrax (powered envelopes) dengue slamonella enteritides ```
bioterrorism agents
81
ricin 1978
georgi markov - bulgarian political exile that received a subQ injection of ricin via an umbrella tip
82
agents that are easily aerosolized, infective, high mortality rate, can cause panic and social disruption are category ___ agents
A
83
ex of category A (5)
``` anthrax (bacillus antrhacis) botulinum toxin (c. botulinum) plage (y. pestis) smallpox (variola major) tularemia (f. tularenis) ```
84
woolsorter's disease
anthrax
85
anthrax spores are
highly resistant to drying, heat, gamma radiation, UV light, and disinfectants can remain dormant for up to 40 yrs
86
anthrax infection occurs in one of four ways
injection inhalation ingestion contact with broken skin
87
anthrax toxin that causes skin problems, inhibits neutrophils, impairs immune system
edema toxin --> causes edema!
88
anthrax toxin that causes a systemic reaction and can lead to death
lethal toxin
89
ABX effect on eschars of cutaneous anthrax
do not alter course of eschar (appearance, scabbing, sloughing) but can prevent systemic infection
90
mortality rate of inhalation anthrax
85 - 90%

MultiSystems (3 decks)

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