used to combat eye infection within the first 24 hoursafter exposure. In severe cases, morphine may begiven to relieve pain.In cases of systemic involvement, British Anti-Lewisite (BAL), dimercaprol, is available in a peanutoil suspension for injection. BAL is a specificantiarsenical that combines with the heavy metal toform a water-soluble, nontoxic complex that isexcreted. However, BAL is somewhat toxic, and aninjection of more than 3 mg/kg will cause severesymptoms.Aside from the use of dimercaprol for the systemiceffects of arsenic, treatment is the same as for mustardlesions.Blood AgentsBlood agents interfere with enzyme functions inthe body, i.e., block oxygen transfer. Hydrocyanic acid(AC) and cyanogen chloride (CK) are cyanide-containing compounds commonly referred to as bloodagents. These blood agents are chemicals that are in agaseous state at normal temperatures and pressures.They are systemic poisons and casualty-producingagents that interfere with vital enzyme systems of thebody. They can cause death in a very short time afterexposure by interfering with oxygen transfer in theblood. Although very deadly, they are nonpersistentagents.SIGNS AND SYMPTOMS OF EXPOSURE.—These vary with concentration and duration ofexposure. Typically, either death or recovery takesplace rapidly. After exposure to high concentrations ofthe gas, there is a forceful increase in the depth ofrespiration for a few seconds, violent convulsions after20 to 30 seconds, and respiratory failure with cessationof heart action within a few minutes.TREATMENT.—There are two suggestedantidotes in the treatment of cyanides: amyl nitrite incrush ampules (provided as first aid) and intravenoussodium thiosulfate solution.In an attack, if you notice sudden stimulation ofbreathing or an almond-like odor, hold your breath anddon your mask immediately. In treating a victim, uponnotification by competent authority that there are noblood agents remaining in the atmosphere, crush twoampules of amyl nitrite in the hollow of your hand andhold it close to the victim’s nose. You may repeat thisprocedure every few minutes until eight ampules havebeen used. If the atmosphere is contaminated and thevictim must remain masked, insert the crushedampules into the mask under the face plate.Whether amyl nitrite is used or not, sodiumthiosulfate therapy is required after the initiallifesaving measures. The required dose is 100 to 200mg/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 thespecific antidote and artificial respiration are givensoon enough, the chance of survival is greatlyenhanced.Choking or Lung AgentsThe toxicity of lung agents is due to their effect onlung tissues; they cause extensive damage to alveolartissue, resulting in severe pulmonary edema. Thisgroup includes phosgene (CG) and chlorine (Cl), aswell as chloropicrin and diphosgene. However, CG ismost likely to be encountered, and its toxic action isrepresentative of the group.Phosgene is a colorless gas with a distinctive odorsimilar to that of new-mown hay or freshly cut grass.Unfortunately, even at minimal concentrations in theair (i.e., below the threshold of olfactory perception),CG can cause damage to the eyes and throat. Generallyspeaking, CG does not represent a hazard of longduration; therefore, an individual exposed to acasualty-producing amount should be able to smell it.SIGNS AND SYMPTOMS OF EXPOSURE.—There may be watering of the eyes, coughing, and afeeling of tightness in the chest. More often, however,there will be no symptoms for 2 to 6 hours afterexposure. Latent symptoms are rapid, shallow, andlabored breathing; painful cough; cyanosis; frothysputum; clammy skin; rapid, feeble pulse; and lowblood pressure. Shock may develop, followed bydeath.TREATMENT.—Once symptoms appear,complete bed rest is mandatory. Keep victims withlung edema only moderately warm, and treat theresulting anoxia with oxygen. Because no specifictreatment for CG poisoning is known, treatment has tobe symptomatic.Incapacitating AgentsIncapacitating agents, which are mainlycomprised of psychochemicals, produce mentalconfusion and an inability to function intelligently.8-8
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