Doctor's Notes on Chemical Warfare
Chemical warfare is the use of chemical agents as weapons of war or terror. The major categories of chemical weapon agents (CWAs) are nerve agents, blistering agents, choking agents (lung toxins), cyanide, incapacitating agents (anticholinergic compounds), lacrimating agents (eye irritants) and vomiting agents. Signs and symptoms vary according to which agent is used. The following is a list of signs and symptoms matched with examples of their causes (CWAs):
- local sweating, muscle twitching, nausea, vomiting, diarrhea, generalize weakness, eye pain; severe symptoms include loss of consciousness, convulsions, paralysis, secretions from the nose, mouth and lungs, difficulty breathing, and death ( nerve agents like sarin, VX and tabun)
- vesicles on the skin (blistering skin) resembling burns, burning eye pain, sore throat, hoarseness, cough, shortness of breath (blistering agents like mustard gas, lewisite)
- choking, difficulty breathing (agents such as chlorine, phosgene)
- headache, confusion, anxiety, nausea/vomiting, shortness of breath, chest pain, loss of consciousness and seizures (cyanide poisoning)
- dizziness, disorientation, nausea and vomiting and difficulty with vision, dilated pupils, reddish skin that is warm and dry, seizures with incapacitating agents like anticholinergics (for example, atropine, 3-quinuclidinyl benzilate)
- eye pain, excessive tear production (riot control agents like pepper gas or spray, chloroacetophenone)
- vomiting, malaise (adamsite)
The causes of the signs and symptoms of many chemical weapons are given in the above examples. However, the signs and symptoms may vary from individual to individual and their severity can depend on such factors as time of exposure, format of exposure (gas, particles, skin exposure, ingestion, for example) and concentration of the agent causing symptoms.
Chemical Warfare Symptoms
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.
- Skin: 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 weight loss.
- 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.
Everyone knows there are germs around them. Some of the places are obvious—you probably wash your hands after cleaning up your cat’s litter, changing a diaper, or using the toilet. But there are places in your home that probably escape your attention, and some of those places need to be cleaned as frequently as germ hot spots you already know.
The easiest way for germs to escape their hiding places and find their way into your body is through your hands. Your hands are constantly interacting with objects in your home, and they’re also what you use to wipe your eyes and nose, and to feed your mouth. That’s a common way for infectious diseases to escape your body’s main natural defense—your skin.
In the following article, learn the environments where germs love to hide. You and your family can enjoy fewer colds and other infections as well as a healthier daily life by learning these germ-filled locations and cleaning them frequently.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.