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 (chemical warfare agents or 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, 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.
What Are the Treatments for Chemical Warfare?
Treatments begin with safe removal of the patients from the chemicals and decontamination, clothing removed, and patient washed with water and diluted bleach, for example. Additional decontaminates may be used like hypochlorite. There are different ways to treat each different compound that may be used for warfare, and there are too many to present in this short summary. Included here are the chemical agents either used or potentially useful for chemical warfare:
- Nerve agent treatments
- Blistering agents
- Consider N-acetylcysteine.
- Consider nebulized sodium bicarbonate
- Treatment for pulmonary edema
- Blood agents (cyanide): first three chemicals used together in a kit
- Amyl nitrite
- Sodium nitrite
- Sodium thiosulfate
- Hydrofluoric acid
- IV calcium gluconate or IV calcium chloride including
- IV magnesium
Supportive care (oxygen intubation, for example) may be required.
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Biological WarfareBiological weapons include any organism (such as bacteria, viruses, or fungi) or toxin found in nature that can be used to kill or injure people. Types of biological agents include anthrax, plague, cholera, tularemia, brucellosis, Q fever, smallpox, monkeypox, arboviral encephalitides, viral hemorrhagic fevers (like Marburg and Ebola virus), staphylococcoal enterotoxin B, ricin, botulinum toxin, mycotoxins, glanders, typhus, and anti-crop biological agents.
Chemical BurnsChemical burns are irritation and destruction of human tissue from exposure to chemicals. Chemical burns can occur in the home, at work or school, and as a result of accident or assault. Most chemical burns are caused by either strong acids or strong bases. Chemical burn symptoms may include redness, irritation, or burning at the site of the contact, pain or numbness at the site of the contact, blisters or black, dead skin at the site of the contact, vision changes if the chemical gets into the eyes, cough or shortness of breath, and vomiting. All chemical burns should be considered potential medical emergencies.
Chemical Eye BurnsChemical burns to the eye or eyelid make up roughly 10% of all eye injuries. Depending on the type of chemical and how long the eye was exposed to it, chemical eye burns can cause complete loss of sight and can be permanently debilitating.
Chemical PneumoniaChemical pneumonia is a type of lung irritation. Many substances can cause chemical pneumonia including liquids, gasses, dust, fumes, and lung aspiration. Symptoms and signs of chemical pneumonia include burning eyes, lips, mouth, throat, dry cough, nausea, abdominal pain, chest pain, headache, and pleuritis. Treatment of chemical pneumonia depends on the toxic and amount of exposure.
Personal Protective Equipment (PPE)Personal protective equipment (PPE) is the term that refers to any garment, respirator, or other piece of gear that protects a person from disease, pathogens, or poisons. PPE is important especially for medical professionals and first-responders to emergencies.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.