is followed in a few hours by irritation of the throat, hoarseness, and a cough. Fever, moist rales, and dyspnea may develop. Bronchopneumonia is a frequent complication; the primary cause of death is massive edema or mechanical pulmonary obstruction.
Because the eye is the most sensitive part of the body, the first noticeable symptoms of mustard exposure will be pain and a gritty feeling in the eye, accompanied by spastic blinking of the eyelids and photophobia.
TREATMENT. There is no specific antidotal treatment for mustard poisoning. Physically removing as much of the mustard as possible, as soon as possible, is the only effective method for mitigating symptoms before they appear. All other treatment is symptomatic; that is, the relief of pain and itching, and control of infection.
Lewisite is an arsenical. This blistering compound is a light to dark brown liquid that vaporizes slowly.
SYMPTOMS. The vapors of arsenical are so irritating that conscious persons are immediately warned by discomfort to put on the mask. No severe respiratory injuries are likely to occur, except in the wounded who are incapable of donning a mask. The respiratory symptoms are similar to those produced by mustard gas. While distilled mustard and nitrogen mustard cause no pain cm the skin during absorption, Lewisite causes intense pain upon contact.
TREATMENT. Immediately decontaminate the eyes by flushing with copious amounts of water to remove liquid agents and to prevent severe burns. Sodium sulfacetamide, 30 percent solution, may be used to combat eye infection after the first 24 hours. In severe cases, morphine may be given to relieve pain.
British Anti-Lewisite (BAL), dimercaprol, is available in a peanut oil suspension for injection in cases of systemic involvement. BAL is a specific antiarsenical, which combines with the heavy metal to form a water-soluble, nontoxic complex that is excreted. However, BAL is somewhat toxic and an injection of more than 3 mg/kg will cause severe symptoms.
Aside from the use of dimercaprol for systemic effects of arsenic, treatment is the same as for mustard lesions.
Hydrocyanic acid (AC) and cyanogen chloride (CK) are cyanide-containing compounds commonly referred to as blood agents. These blood agents are chemicals that are in a gaseous state at normal temperatures and pressures. They are systemic poisons and casualty-producing agents that interfere with vital enzyme systems of the body. They can cause death in a very short time after exposure by interfering with oxygen transfer in the blood. Although very deadly, they are nonpersistent agents.
These vary with concentration and duration of exposure. Typically, either death or recovery takes place rapidly. After exposure to high concentrations of the gas, there is a forceful increase in the depth of respiration for a few seconds, violent convulsions after 20 to 30 seconds, and respiratory failure and cessation of heart action within a few minutes.
There are two suggested antidotes in the treatment of cyanides. Amyl nitrite in crush ampulcs is provided as first aid. Followup therapy with intravenous sodium thiosulfate solution is required.
In an attack, if you notice sudden stimulation of breathing or an almondlike odor, hold your breath and don your mask immediately. In treating a victim, if no blood agents remain present in the atmosphere, crush 2 ampules of amyl nitrite in the hollow of your hand and hold it close to the victims nose. This may be repeated every few minutes until 8 ampules have been used. If the atmosphere is contaminated and the victim must remain masked, insert the crushed ampules into the mask under the face plate.
Whether amyl nitrite is used or not, sodium thiosulfate therapy is required after the initial lifesaving measures. The required dose is 100 to 200 mg/kg given intravenously over a 10-minute period.
The key to successful cyanide therapy is speed; cyanide acts rapidly on an essential enzyme system. The antidotes act rapidly to reverse this action. If the specific antidote and artificial respiration is given soon enough, the chance of survival is greatly enhanced. 12-5