Chemical Warfare (cont.)
Jeffrey L Arnold, MD, FACEP
Francisco Talavera, PharmD, PhD
Raymond J Roberge, MD, MPH, FAAEM, FACMT
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.
Chemical burns caused by mustard often appear deceptively superficial at first. Earliest symptoms are itching, burning, and stinging pain over exposed areas. Moist, thinner skin is affected more severely. Affected areas appear red and swollen. If contamination is more extensive, superficial blisters occur within 24 hours of exposure. Most
burns are partial thickness, but full-thickness burns with deep blisters may result from exposure to higher concentrations. Blister fluid does not contain active mustard and is not toxic.
- Eyes: Eyes are especially sensitive to the effects of mustard. Symptoms begin 4-8 hours after exposure. Earliest symptoms include burning pain, a feeling that something is in the eye, sensitivity to light, tearing, and blurred vision. Permanent corneal scarring and blindness may occur with severe exposures, but is rare.
- Respiratory tract: Mustards primarily damage tissues in the upper airway through a direct inflammatory effect. Following a period of 2-24 hours after exposure, symptoms may appear. Early symptoms include sinus congestion, a
sore throat, and hoarseness. Later,
cough, shortness of breath, and trouble breathing may develop. People with severe and extensive contact with mustard gas may develop respiratory complications up to several days after exposure.
- Gastrointestinal tract: Rarely, mustard damages rapidly growing cells of the intestinal tract. GI involvement results in
abdominal pain, nausea, vomiting, diarrhea, and
- Blood system: Rarely, mustards cause unpredictable loss in the production of bone narrow. Certain specialized cells begin dying 3-5 days after exposure reaching its worst point in 3-14 days, depending on the severity of exposure.
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.
- Remove clothing immediately and wash the skin with soap and water.
- Eye exposure requires immediate washing out with a large amount of saline or water.
- Decontamination after the first few minutes of exposure does not prevent further damage later but at least prevents spread of the chemical to other parts of the body and protects emergency care personnel from further contact exposure.
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