Buddy Aid.—If you encounter a service membersuffering from severe signs of nerve-agent poisoning,you should provide the following aid:Mark the casualty, if necessary. Do not fasten thehood.Administer, in rapid succession, three sets of thenerve-agent antidotes. Follow the proceduresfor administration as described previously in theself-aid section.NOTE: U s e t h e c a s u a l t y ’s o w nautoinjectors when providing aid. Do notuse your injectors on a casualty. If you do,you may not have any antidote availablewhen needed for self-aid.Blister Agents (Vesicants)Blister agents, or vesicants, exert their primaryaction on the skin, producing large and painful blistersthat are incapacitating. Although vesicants are classedas nonlethal, high doses can cause death.Common blister agents include mustard (HD),nitrogen mustard (HN), and Lewisite (L). Each ischemically different and will cause significant specificsymptoms. They are all similar in their physicalcharacteristics and toxicology. Mustards areparticularly insidious because they do not manifesttheir symptoms for several hours after exposure. Theyattack the eyes and respiratory tract as well as the skin.There is no effective therapy for mustard once itseffects become visible. Treatment is largelysupportive: to relieve itching and pain, and to preventinfection.M U S TA R D ( H D ) A N D N I T R O G E NMUSTARD (HN).—HD and HN are oily, colorless orpale yellow liquids, sparingly soluble in water. HN isless volatile and more persistent than HD but has thesame blistering qualities.Signs and Symptoms of Exposure.—The eyesare the most vulnerable part of the body to mustard gas.Contamination insufficient to cause injury elsewheremay produce eye inflammation. Because the eye is themost sensitive part of the body, the first noticeablesymptoms of mustard exposure will be pain and agritting feeling in the eyes, accompanied by spasticblinking of the eyelids and photophobia. Vapor orliquid may burn any area of the skin, but the burns willbe most severe in the warm, sweaty areas of the body:the armpits, groin, and on the face and neck. Blisteringbegins in about 12 hours but may be delayed for up to48 hours. Inhalation of the gas is followed in a fewhours by irritation of the throat, hoarseness, and acough. Fever, moist rales, and dyspnea may develop.Brochopneumonia is a frequent complication. Theprimary cause of death is massive edema ormechanical pulmonary obstruction.Treatment.—There is no specific antidotaltreatment for mustard poisoning. Physically removingas much of the mustard as possible, as soon as possible,is the only effective method for mitigating symptomsbefore they appear. All other treatment issymptomatic, that is, the relief of pain and itching, andcontrol of infection.LEWISITE (L).—Lewisite is an arsenical (anarsenic-based compound). This blistering compoundis a light- to dark-brown liquid that vaporizes slowly.Signs and Symptoms of Exposure.—The vaporsof arsenicals are so irritating that conscious persons areimmediately 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 amask. The respiratory symptoms are similar to thoseproduced by mustard gas. While distilled mustard andnitrogen mustard cause no pain on the skin duringabsorption, Lewisite causes intense pain upon contact.Treatment.—Immediately decontaminate theeyes by flushing with copious amounts of water toremove liquid agents and to prevent severe burns.Sodium sulfacetamide, 30 percent solution, may be8-7HM3F0806Figure 8-6.—One set of used autoinjectors attached to a pocketflap.
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