Chemical Warfare (cont.)
Jeffrey L Arnold, MD, FACEP
Suzanne White, MD
Francisco Talavera, PharmD, PhD
Raymond J Roberge, MD, MPH, FAAEM, FACMT
IN THIS ARTICLE
Mustards Signs, Symptoms, Diagnosis, and Decontamination
Mustards signs and symptoms
Mustards injure the skin, eyes, respiratory tract, GI tissues, and blood system. The pattern of toxicity depends partly on whether the person is exposed to liquid or vapor. Liquid exposure primarily damages the skin, producing an initial rash followed by blistering similar to a partial-thickness burn. Vapor exposure damages the upper respiratory tract (skin usually is not affected). Mustards penetrate cells in less than 2 minutes, yet signs and symptoms usually are delayed 4-6 hours (the range can be from 1-24 hours). The time it takes to show symptoms is shorter with high-concentration exposures, such as those occurring at increased room temperature and humidity.
Diagnosis of mustard exposure is based on what the doctor observes from the person’s signs and symptoms. No laboratory tests are useful.
Personal protective equipment: Liquid mustard contamination poses a risk for emergency care personnel. Ideally, they will be wearing appropriate personal protective gear.
Immediate decontamination within 2 minutes of exposure is the most important intervention for people who have skin exposure to mustard, because it rapidly becomes fixed to tissues, and its effects are irreversible. Even if an exposure takes place and a person shows no obvious sign and symptoms, decontamination is still urgent.
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