used to combat eye infection within the first 24 hours
after exposure. In severe cases, morphine may be
given to relieve pain.
In cases of systemic involvement, British Anti-
Lewisite (BAL), dimercaprol, is available in a peanut
oil suspension for injection.
BAL is a specific
antiarsenical that 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
Aside from the use of dimercaprol for the systemic
effects of arsenic, treatment is the same as for mustard
Blood agents interfere with enzyme functions in
the body, i.e., block oxygen transfer. 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
SIGNS AND SYMPTOMS OF EXPOSURE.
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 with cessation
of heart action within a few minutes.
TREATMENT.There are two suggested
antidotes in the treatment of cyanides: amyl nitrite in
crush ampules (provided as first aid) and intravenous
sodium thiosulfate solution.
In an attack, if you notice sudden stimulation of
breathing or an almond-like odor, hold your breath and
don your mask immediately. In treating a victim, upon
notification by competent authority that there are no
blood agents remaining in the atmosphere, crush two
ampules of amyl nitrite in the hollow of your hand and
hold it close to the victims nose. You may repeat this
procedure every few minutes until eight 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 9-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 are given
soon enough, the chance of survival is greatly
Choking or Lung Agents
The toxicity of lung agents is due to their effect on
lung tissues; they cause extensive damage to alveolar
tissue, resulting in severe pulmonary edema. This
group includes phosgene (CG) and chlorine (Cl), as
well as chloropicrin and diphosgene. However, CG is
most likely to be encountered, and its toxic action is
representative of the group.
Phosgene is a colorless gas with a distinctive odor
similar to that of new-mown hay or freshly cut grass.
Unfortunately, even at minimal concentrations in the
air (i.e., below the threshold of olfactory perception),
CG can cause damage to the eyes and throat. Generally
speaking, CG does not represent a hazard of long
duration; therefore, an individual exposed to a
casualty-producing amount should be able to smell it.
SIGNS AND SYMPTOMS OF EXPOSURE.
There may be watering of the eyes, coughing, and a
feeling of tightness in the chest. More often, however,
there will be no symptoms for 2 to 6 hours after
exposure. Latent symptoms are rapid, shallow, and
labored breathing; painful cough; cyanosis; frothy
sputum; clammy skin; rapid, feeble pulse; and low
Shock may develop, followed by
TREATMENT.Once symptoms appear,
complete bed rest is mandatory. Keep victims with
lung edema only moderately warm, and treat the
resulting anoxia with oxygen. Because no specific
treatment for CG poisoning is known, treatment has to
Incapacitating agents, which are mainly
comprised of psychochemicals, produce mental
confusion and an inability to function intelligently.