B-NICE
Biological Nuclear Incendiary Chemical and Explosive weapons
CBRNE
Chemical, Biologic, Radiologic, Nuclear, and Explosive weapons
During a WMD call, you should stage your vehicle ____ from the incident.
1-2 blocks
Vesicant agents consist of :
sulfur mustard, lewisite, and phosgene oxime
Signs of vesicant exposure to skin
Skin irritation, burning, and reddening Immediate, intense skin pain Formation of large blisters Gray discoloration of skin Swollen and closed or irritated eyes Permanent eye injury
Inhaled: Hoarseness and stridor Severe cough Hemoptysis Severe dyspnea
Signs and symptoms of mustard gas exposure produces :
4-6 hours after exposure
Mutagen is considered a mutagen which means?
It mutates, damages, and changes the structures of cells.
Characteristics of mustard gas
Brownish, yellowish oily substance
Smell of garlic or mustard
Affects moist, damp areas more - respiratory, armpits, groin
Difference between mustard gas and lewisite/phosgene oxime.
Onset of symptoms form more rapidly in lewisite and phosgene oxime exposures.
s/s of chloride exposure
Upper airway irritation Choking sensation SOB Tightness of chest Hoarseness and stridor Gasping and coughing Pulmonary edema Complete airway constriction Death
Management of pulmonary agents
Aggressively manage ABCs with particular attention to oxygenation, ventilation, and suctioning. Do not allow pt to be active. Gain IV access Position of comfort w/ head elevated Initiate prompt transport Consider ALS
Characteristics of phosgene
Pulmonary agent
Delayed onset of sxs
Freshly mowed grass or hay odor
s/s of phosgene exposure
Mild : Nausea Tightness of chest Severe cough DOE
Severe: Dyspnea at rest Excessive pulmonary edema Hypovolemia Hypotension
Characteristics of sarin (GB)
Nerve agent
Highly volatile colorless and odorless liquid.
Turns from liquid to gas w/in seconds to minutes @ room temp.
Respiratory tract main route.
Characteristic of soman (GD)
Nerve agent
Twice as persistent as sarin and 5x as lethal.
Fruity odor
Additive causes it to bind to cell to attack faster.
Skin absorption and respiratory tract route.
Characteristics of tabun (GA)
Nerve agent
Half as lethal as sarin and 36 x more persistent.
Remains present for several days.
Fruity odor
Skin absorption and respiratory tract transmission route.
Characteristics of V agent (VX)
Nerve agent
Clear oily agent with no odor and looks like baby oil.
100 x more lethal than sarin and extremely persistent.
DUMBELS mnemonic
Diarrhea Urination Miosis, muscle weakness Bradycardia, bronchospasm, bronchorrhea Emesis Lacrimation Seizures, salivation, sweating
SLUDGEM
Salivation, sweating Lacrimation Urination Defecation Gastric upset and cramps Emesis Muscle twitching/miosis
What is the most common symptom of nerve agent exposure?
Miosis
DuoDote Auto-Injection
Contains 2.1 mg of atropine and 600 mg of pralidoxime chloride (2-PAM)
Pathophysiology of Duo-Dote
Atropine blocks nerve agent
2-PAM eliminates agent from body
s/s of metabolic agents
Low doses: Dizziness Light-headedness Headache Vomiting
Higher doses: SOB, gasping respirations Respiratory distress or arrest Tachypnea Flushed skin Tachycardia AMS Seziures Coma Apnea Cardiac arrest
Cyanide
Metabolic agent
Colorless gas
Similar odor to almonds
Affects body’s ability to use oxygen
Cyande treatment
Remove all clothing Decontaminate Support ABCs IV access Aggressive oxygenation and ventilation w/ supplemental oxygen for severe exposure Always use BVM ALS if no antidote available
Biologic agents are grouped as
Viruses
Bacteria
Neurotoxins
Characteristics of smallpox
Virus biologic agent
Most contagious when blisters begin to form
PPE : HEPA-filter, gloves, eye protection
s/s of smallpox
High fever Body aches Headaches Rash - identical in development, begin on face and extremities Blister
Characteristics of viral hemorrhagic fevers (VHFs)
Virus biological agent
Group of diseases caused by Ebola, Rift Valley, Marburg, and yellow fever.
Causes blood in the body to seep out of tissues and blood vessels.
s/s of VHFs
Sudden onset of fever, weakness, muscle pain, headache, and sore throat.
Followed by vomiting and internal and external bleeding.
Characteristics of antrhax
Bacterial biological agent
Routes - inhalation, cutaneous, GI
Inhalation deadliest
Treatment - abx
s/s of anthrax
Flulike sxs Fever respiratory distress w/ tachycardia Shock Pulmonary edema Respiratory failure after 3-5 days of flulike sxs
Medical management of anthrax
Pulmonary : Standard precautions, oxygen, ventilatory support, and transport
cutaneous : standard precautions, apply dry sterile dressing to prevent accidental contact w/ wounds and fluids
Medical management of smallpox
Standard precautions
Support ABCs
Medical management of VHF
Standard precautions
Support ABCs
Tx for shock and hypotension of present
Characteristics of plague
Bacterial biological agent
Natural vectors are rodents and fleas
Bubonic plague
Infects lymphatic system causing them to grow large and round, forming buboes. Infection may spread through the body leading to sepsis and possible death. Not contagious.
Pneumonic plague
Lung infection that results from inhalation of plague bacteria. Contagious and much higher death rate than bubonic.
Medical management of plague agents
Standard precautions
Supportive ABCs
Oxygen if indicated
s/s of botulinum toxin
Dry mouth Intestinal obstruction Urinary retention Constipation N/V Abnormal pupil dilation Blurred vision, dipoplia, drooping eyelids Dysphagia, difficulty speaking Respiratory failure
Medical management of botulinum toxin
Supportive ABCs
Ventilatory support if paralysis of respiratory muscles
Characteristics of botulinum
Neurotoxin
Affects nervous system’s function. Eventually muscle paralysis occurs beginning in head and face, spreading downward.
Characteristics of ricin
Neurotoxin
Mash left from castor bean
1-3 mg is lethal
Least toxic by oral rout due to poor absorption.
s/s of ingested ricin
4-8 hours after exposure Fever Chills Headache Muscle aches N/V/D Severe abdominal cramping Dehydration GI bleeding Necrosis of liver, spleen, kidneys, and GI
s/s of inhaled ricin
4-8 hours after exposure Fever Chills Nausea Local irritation of eyes, nose, and throat Profuse sweating Headache Muscle aches Nonproductive cough CP Dyspnea Pulmonary edema Severe lung inflammation Cyanosis Seizures Respiratory failure
Medical management of ricin exposure
Support ABCs
IV access and nl saline for dehydration
Early intubation for pulmonary edema
Ionizing radiation
Energy emitted in the form of rays or particles
Alpha radiation
Least harmful
Cannot penetrate through most objects (paper, skin)
Beta radiation
Slightly more penetration than alpha.
Requires layer of clothing to stop it.
Gamma (x-ray) radiation
Travels faster and has more energy than alpha and beta.
Easily penetrate though human body and require lead or several inches of concrete to prevent penetration.
Neutron radiation
Most powerful
Easily penetrate through lead and require several feet of concrete to stop them.
