Disaster Detect

Question 1

What are some chemical agent clues?

Answer 1

Rapid symptom onset, multiple victims, EMTs effected, disseminated device used, animal or insect die off

Question 2

Describe the choking agent Phosgene.

Answer 2

Smells like newly cut hair

Coughing, choking, vomiting

Question 3

Describe the choking agent Chlorine.

Answer 3

Swelling like swimming pools

Coughing, choking, vomiting

Question 4

Describe blistering agent of Mustard.

Answer 4

Smells like garlic, symptom onset delayed

Tearing, eye itching, running nose, cough, blistering

Question 5

Describe the blister agent of Lewisite.

Answer 5

Smells like geraniums, immediate onset

Tearing, eye itching, running nose, cough, painful blisters

Question 6

Describe blood agent of Cyanide gas.

Answer 6

Smells like bitter almonds, rapid onset

Normal skin color, gasping for air, shock

Question 7

What are the nerve agents?

Answer 7

Tabun, sarin, soman, VX

Question 8

What are the symptoms of nerve agents?

Answer 8

Rapid to 48 hr onset, pinpoint pupils, salivation, runny nose, shortness of breath, chest tightness, nausea, muscle twitch, seizures, coma, death

Question 9

What are the characteristics of a biological agent?

Answer 9

May not have an scene, hard to detect, beware of multiple people with similar complaints in “healthy” population

Question 10

Describe bacillus anthracis as a biological agent.

Answer 10

Spore forming, sheeps and cattle, 2-60 day incubation

Inhalation, cutaneous, GI

Question 11

What is the presentation and prognosis of cutaneous anthrax ?

Answer 11

Local edema, itchy bump to blister, painless, depressed eschar
Untreated = 20% dead
Treated = 0% dead

Question 12

What is the presentation for inhalation anthrax?

Answer 12

Non-specific “flu-like” symptoms to abrupt respiratory failure
Widened mediastinum and/or pleural effusions on chest rad

Question 13

How is anthrax diagnosed?

Answer 13

Cutaneous - clinical, culture beneath eschar

Inhalation - blood culture, chest rad

Question 14

What are the features of yersina pestis (plague)?

Answer 14

10 natural cases a year
Usually lymph node/blood infection
Pneumonic plague for bioterrorists

Question 15

What is the clinical presentation for the plague?

Answer 15

Flea bite - bubonic
Inhalation - pneumonic
Incubates for 2-3 days, high fever, chills, headache, coughing blood, toxic look

Question 16

How is the plague diagnosed?

Answer 16

Staining of sputum (gram neg), culutres

Question 17

What is the route of infection for tularemia (Francisella tularensis) and the presentation?

Answer 17

Tick and fly bites, infected animals and inhale

Incubation 1 - 21 days, acute febrile illness, pneumonia, conjunctivitis or skin ulcers, swollen lymph nodes

Question 18

How is tularemia diagnosed?

Answer 18

Culture of blood and sputum (neg coccobaccillus)

Question 19

What are the features of small pox?

Answer 19

7-17 day incubation, prodrome, 2-3 day rash, 8-10 rash with pustules then scabs

Question 20

Describe Viral hemorrhagic fever?

Answer 20

Variants (Ebola, Marbug, Lassa, Dengue)
Naturally occurring - mircovascular damage
Incubation 2-21 days, non-specific prodrome, flushing in face and chest, petechiae
Shock and generalized mucous membrane hemorrhage

Question 21

How is viral hemorrhagic fever diagnosed?

Answer 21

Clinical presentation, high level index of suspicion

If pt thought to present with VHF report before results

Question 22

Describe SARS (severe acute respiratory syndrome)?

Answer 22

Coronavirus, world-wide in 2003
Incubation 2-7 days (up to 10), presents flu-like prodrome, diarrhea, respiratory symptoms on day 3-7
Development of pneumonia

Question 23

Describe Ricin.

Answer 23

Castor beans, exposed bu injection, inhalation ingestion
Inhalation - fever, cough, chest pain, pulmonary edema
Ingestion, nausea, vomit, diarrhea, GI hemorrhage

Question 24

What are the features of boutlinum toxin?

Answer 24

Clostridium botulinum, neurotoxin, inhale or ingestion
Presents 24-36 hrs after ingestion
Blurred and double vision, slurred speech, swallow issues, descending paralysis, respiratory failure

Question 25

How is botulism diagnosed?

Answer 25

Based on presentation, toxin assay of blood

Question 26

S.A.F.E.T.Y.

Answer 26

Skin rash with fever (smallpox)
Acute pulmonary syndrome (anthrax/plague)
Flue like syndrome (Tularemia/SARS)
Excessive bleeding (Viral hemorrhagic fever)
Toxin effect (Botulism)
Your personal/community safety

Question 27

What is step one of surveillance?

Answer 27

Ongoing monitoring of your environment and your patient population for unusual events

Question 28

What is step two of surveillance?

Answer 28

Communication of any worrisome observation to a 911 operator or appropriate health department contact

Question 29

Describe the signs and symptoms of a radiological event.

Answer 29

Delayed onset, early symptoms predicts worse outcome, nausea, vomit, burns