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1
Q

kaffa

A

tartar troops flung bodies of plague via a catapult in 1346

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2
Q

French-Indian War

A

Smallpox blankets from hospitals to Natives in 1757

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3
Q

World War One

A

i. Chlorine gas in trench warfare in 1915

ii. German troops fired shells of phosgene in 1918

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4
Q

Georgi Markov

A

Bulgarian political exile assassinated with a ricin pellet in umbrella tip in 1978

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5
Q

Bhagwan Shree Rajneesh

A

Cult in Oregon that contaminated salad bars with Salmonella enteritides to disrupt elections in 1984

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6
Q

Aum Shinrikyo cult

A

i. Anthrax aerial release of spores in Tokyo in 1994

ii. Sarin gas release in 1995

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7
Q

Kim Jong-nam

A

Lethal nerve agent (VX) in 2017

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8
Q

organophosphates
pesiticides
warfare agents: G series & VX

A

nerve agents

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9
Q

What are the G series nerve agents (3)

A

sarin gas
soman
tabun

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10
Q

Toxicity occurs from inhibition of AChE at the NMJ resulting in constant exposure and production of ACh that stimulates the post-synaptic neuron

A

nerve agent MOA

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11
Q

neuromuscular synapses are effected by affects on the ___ type of receptors

A

nicotinic

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12
Q

neuroglandular synapses are effected by affects on the ___ type of receptors

A

muscarinic

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13
Q

organophosphate + AChE bind to form an irreversible inactivation of the phosphorylated AChE

A

aging process of nerve agents

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14
Q

DUMBBBELLS of nerve agents

_____ effects

A

MUSCARINIC effects

1) D: Diarrhea
2) U: Urination
3) M: Miosis –> dominates over mydriasis
4) B: Bradycardia
5) B: Bronchospasm
6) B: Bronchorrhea
7) E: Emesis
8) L:Lacrimation
9) L: Lethargy
10) S:Salivation

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15
Q

MTWHF of nerve agents

_____ effects

A

NICOTINIC effects

1) M: mydriasis
2) T: tachycardia –> dominates over bradycardia
3) W: weakness
4) H: HTN
5) F: fasciculations

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16
Q

Seizure treatment with nerve agents

A

midazolam - benzos

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17
Q

muscarinic treatment to prevent secretions with nerve agents

A

atropine

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18
Q

nicotinic treatment to prevent muscular paralysis

when is it most effective?

A

pralidoxime - most effective before aging process

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19
Q

examples of blistering agents (4)

A

i. Nitrogen Mustard
ii. Sulfur Mustard
iii. Lewisite
iv. Phosgene

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20
Q

toxicity of blistering agents:

Where does it damage the most?

What does the damage look like?

How long before sx are seen?

What agent damages the earliest?

A

i. Exerts damage on actively proliferating cells: basal epidermal cells, hematopoietic cells, mucosal lining of intestines

ii. Damages the skin causing blistering and irritation in a “string of pearls” distribution that overlies “normal” severely damaged skin
1) Most damaging to the eyes

iii. Mustards can take 4 - 12 hours to show
iv. Lewisite damages immediately

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21
Q

Garlic/horseradish odor

A

sulfur mustard

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22
Q

geraniums

A

lewisite

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23
Q

fruity odor/no odor/musty/fishy odor

A

nitrogen mustard

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24
Q

blood agents (2)

A

hydrogen cyanide

cyanogen chloride

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25
How does cyanide effect the ETC? What organs are effected the most?
i. Cyanide travels to the mitochondria of cells, binds ferric irons and inactivates the cytochrome oxidase of the electron transport chain to induce anaerobic respiration resulting in elevated levels of lactic acid & high anion gap metabolic acidosis ii. Hits the heart and CNS the hardest
26
bitter almonds/peach kernels odor
hydrogen cyanide
27
pungent biting odor
cyanogen chloride
28
HA, N, vertigo, rapidly improve
small exposures to hydrogen cyanide (blood agent)
29
HA, N, vertigo, seizures/coma
moderate exposures to hydrogen cyanide (blood agent)
30
rapidly die due to rapid/deep breathing, convulsions, respiratory/cardiac failure
large exposures to hydrogen cyanide (blood agent)
31
Difference in manifestations between blood agents hydrogen cyanide and cyanogen chloride
Cyanogen chloride is the same as hydrogen cyanide except there is more respiratory damage
32
correcting metabolic acidosis utilizes what drug
sodium bicarb
33
what basic element is used to treat cyanide exposure, unlike in carbon monoxide poisoinings
oxygen
34
cyanide antidote kit: amyl nitrate and sodium nitroprusside
1) Inhale amyl nitrate and IV inject sodium nitroprusside | 2) Binds to CN in the ETC to remove it from the ferric iron and is converted to methemoglobin
35
cyanide antidote kit: sodium thiosulfate
converts CN to thiocyanate to renally excrete
36
cyanide antidote kit: hydroxocobalamin
converts CN to cyanocobalamin to renally excrete
37
what are the choking agents? (2)
- phosgene | - chlorine gas
38
phosgene odor
newly mown/musty hay
39
phosgene requires what unique care
refrigeration
40
hydrolysis of phosgene: what's the equation? what element of the equation causes what damage? What's the edema you see with phosgene exposure?
- > phosgene and water = HCl + CO a) Hydrochlorous acid causes epithelial damage and necrosis of airways b) Severe non-cardiogenic pulmonary edema
41
acylation of phosgene results in what clinical manifestations
more pulmonary damage --> acute lung injury
42
how doe chlorine affect the body
Chlorine and airway water causes hypochlorous acid and oxygen free radicals that's highly damaging to the airway
43
what makes biological agents appealing? (4)
1. cheap 2. require little knowledge 3. allows evasion 4. nonspecific onset that is hard to differentiate
44
category A agents and microbes (6)
1. anthrax (b. anthracis) 2. plague (Y. pestis) 3. botulinum (C. botulinus) 4. smallpox (variola major) 5. tularemia 6. viral hemorrhagic fevers
45
category B agents (4)
1. ricin toxoalbumin from ricinus communis of castor beans 2. brucellosis 3. glanders 4. Q fever
46
category C agents - things that can become problems (4)
1. hantavirus 2. influenza, avian influenza 3. SARS-CoV 4. MERS
47
anthrax is AKA
woolsorter's disease
48
spores of anthrax are highly resistant to ___, ___, ____, ____, and ____
Spores are highly resistant to drying, heat, gamma radiation, UV light, and many disinfectants
49
what are the four ways to become infected with anthrax
1. inhalation 2. injection 3. ingestion 4. cutaneous
50
virulence of anthrax is based on three distinct proteins:
``` lethal factor (LF) protective antigen (PA) edema factor (EF) ```
51
how does anthrax get the edema toxin? what does it do to the body?
edema factor and the protective antigen combine and give skin manifestations of anthrax, pulmonary edema, and peripheral edema
52
how does anthrax get the lethal toxin? what does it do to the body?
lethal toxin is a combo of the lethal factor and the protective agent that results in systemic reactions, hypovolemia, hypotension, and death
53
what's the dx factor of anthrax
nodes of the peribronchial tree from inhalation anthrax
54
CXR of anthrax
widened mediastinum and pleural effusions
55
ABX to treat anthrax and what's the effect? how long to treat?
1. ciprofloxacin gives CNS penetration 2. meropenem gives bactericidal effects 3. linezolid inhibits protein synthesis and prevents production of factors, antigens, and toxins give for 2 to 3 weeks
56
how do you treat cutaneous anthrax
any FQ or doxycycline --> don't need the CNS penetration so safe to use doxy
57
what's the most toxic substance known
botulinum toxin
58
how is botulinum toxin deadly
toxin irreversibly binds peripheral cholinergic synapses in the NMJ to result in permanent muscle paralysis
59
4 D's of botulinum
1. dyphonia 2. dysphagia 3. diplopia 4. dysarthria
60
clinical manifestations of the paralysis
progressive descending skeletal muscle paralysis and respiratory failure
61
effects of ABX on botulinum toxin
no effect
62
cannot give what to treat botulinum toxin as there is no ACh in the synapses
atropine
63
so how do you treat botulinum
antitoxin and supprotive care make sure to check for equine serum allergy to antitoxin via dermal injection first
64
smallpox vs. chickenpox
smallpox: synchronous changes in lesions and centrifugal distribution chickenpox: asynchronous changes in lesions and centripetal distribution
65
how do you get ricin toxalbumin
easily extracted from castor beans
66
what does the ricin toxin do to the cells? to the body?
inhibits protein synthesis and DNA replication in cells leads to DIC and micro-circulatory failure
67
how do you treat ricin
no treatment --> supportive and aggressive airway control
68
very light, charged particle that in large quantities can damage the basal statum of the skin what sensitive body part is most affected by this particle?
beta particles most damaging to the lens of the eyes
69
what particle is similar to x-ray waves and can penetrate the whole body
gamma particles
70
what particle causes 20x the damage of gamma rays
neutrons
71
damage to what body part by radiation results in severe hemorrhage, severe fluid loss, and severe electrolyte loss
gastrointestinal damage as one of the most highly proliferative tissues in the body
72
food irradiation plants
cobalt-60
73
x-rays and cancer treatments
cesium-137
74
nuclear batteries
strontium-90
75
effects on the body from the explosion itself
primary blast effects
76
effects of the materials blown outward and into the body larger radius of effect than the explosion itself
secondary blast effects
77
effects on the body from being a projectile
tertiary blast effects
78
effects of the chemicals and resulting burns on the body
quaternary blast effects
79
primary blast effects include what injuries
blast lung | aortic rupture
80
what injuries result from blast lung
triad of apnea, bradycardia, hypotension
81
what injuries result from aortic rupture
aorta is sandwiched between heart and spinal column
82
what are three specific injuries that occur with primary blast effects
1. shearing 2. spalling 3. imploding
83
what's spalling
more dense tissues turn into little "bullets" and move into the less dense tissues
84
what's imploding
pressure from the blast explosions forces and compresses gas into tissues that cause them to implode on themselves
85
tertiary effects of picking up people and moving them as projectiles heavily effects what are two other injuries common in teritary blast effects?
pediatrics as they weigh less also includes crush injuries and coup-countercoup
86
quaternary blast effect injuries include
thermal/chemical burns inhalation exposures
87
what five things occur in the hot/red zone of a mass casualty?
1. manage airway (nasopharyngeal tube) 2. give 2 rescue breaths in peds 3. autoinjectors (antitoxin or epi) 4. needle decompression of tension pneumothorax 5. tourniquet use to control bleeds
88
what does SALT stand for? what's it used for?
triage method of Sort, Assess, Lifesaving interventions, Treatment/transport
89
i. Require immediate care and will survive: things that complicate airway, circulation, or breathing 1) Mechanical airway obstruction 2) Sucking chest wound 3) Tension pneumo 4) Maxillofacial wounds with airway compromise 5) Unstable chest/abdominal wounds 6) Incomplete amputations 7) Exsanguinating hemorrhage 8) 2nd/3rd degree burns
red triage category
90
Can delay care but will need attention: minor surgical repairs, minor crush injuries, minor cuts/wounds
yellow triage category
91
Require minimal care - more than first aid, and need to be moved out of the triage area: superficial wounds, closed/uncomplicated fx, blast eardrum, psych/emotional disorders, small burns (1st/2nd)
green triage category
92
Those that need to be comforted as they die: they need a lot of unavailable resources to survive
gray triage category
93
Those that are deceased: not even alive when you get there/nothing to be done to save them
black triage category
94
what does MARCH-H stand for
``` Massive hemorrhage Airway compromise Respirations Circulation Head injuries Hypothermia ```
95
eye opening stages of glasgow coma scale
1: no response 2: react to pain 3: open on command 4: open spontaneously
96
verbal response of glasgow coma scale
1: no response 2: incomprehensible sounds 3: inappropriate words 4: confused 5: oriented to time/person/place
97
motor response of glasgow coma scale
1: no response 2: abnormal extension (cerebrate posturing) 3: abnormal flexion (decorticated) 4: withdrawals from pain 5: moves towards pain 6: obeys commands
98
spinal vs. neurogenic shock
spinal shock loses sensations neurogenic shock loses hemodynamic stability - triad of hypotension, bradycardia, peripheral vasodilation
99
stages of hypothermia: i. Body compensates by bumping up metabolic rate: Shivering, HTN, tachycardia, tachypnea, vasoconstriction
mild
100
stages of hypothermia: i. Freeze up: Amnesia, difficulty speaking, unable to use hands, difficulty walking, crazy acting, lose pain reception, comatose
severe
101
stages of hypothermia: i. Body starts to slow: 1) Slow and labored movement, paradoxical undressing 2) Cyanotic lips, ears, fingers, toes 3) Really start acting weird
moderate
102
stay away from STD's:
Shielding Time Distance
103
Distance of radiation exposure
1/x^2

MultiSystems (3 decks)

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