Chemical Warfare
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Sung dynasty, 429 BC: arsenical smokes
WWI: developed by Germans, chlorine gas; 5000 immediate casualties.
     July 1917--Mustard Gas, killed 100,000, 1.5 million injured.
1937:  Nerve Agents invented by Germans: more potent (1mg deadly)
WWII: Germans worried about Allied use, so very little use.
1984:  Iraq against Iran
1988:  Iraq against Kurds

þ Blistering Agents (Vesicants): very persistent
Mustard Gas, Nitrogen Mustard, Lewisite, phosgene oxime
 - eye inflammation and blepharospasm, temporary blindness
 - skin burns and blistering in 4-12 hours or later; worse in moist areas.
 - lungs: pneumonia and pulmonary edema common.
 - bone marrow suppression later.
 Rx: decontaminate, symptomatic relief, burn care, BAL for Lewisite (Soviets
 have large stocks of Lewisite)

þ Blood Agents:  Rapid recovery or death within 30'
 Cyanide-containing
  Rx: AMyl nitrate and Na thiosulfate
 Arsenic-containing
  also causes renal/hepatic damage, lots of hemolytic anemia and hemoglobinermia
  Chelation not effective; transfusion/dialysis

þ Choking Agents:  massive pulmonary edema
  early mild symptoms:  evacuate to tertiary care center in 4-6 hours
  Aminophylline, IV (1g/day) and inhaled steroids (Q10' if not intubated)
  Phosgene and Chlorine

þ Nerve Gas:  colorless, odorless, water soluble, long-lasting
  purified by chlorinating agents, alkaline treatment
  All organophosphates, inhibit (irreversibly) acetyl cholinesterases.
  parasympathetic, sympathetic, nicotinic, and CNS effects (SLUDGE: salivation,
  lacrimation, urination, diarrhea, and muscle spasms, miosis, CNS effects).
GD - Soman
GA - Tabun
GB - Sarin
VX (penetrates skin well)
  Rx:
  - block effects:  block muscarinic with Atropine Q5-10'; up to 15-20 mg
    over 2-3 hours
  - regenerate cholinesterase (if can treat early) with 2-PAM chloride (1-2 g
    ASAP)
  - benzodiazepines
  - intubate and ventilate for paralysis

Mark I antidote kit:  2 mg atropine, 2-PAM chloride 600 mg.  Each soldier has 3.
Supposed to put empties through flap on hip of suit.

Pyridostigmine bromide tablets Q8H:  take for 2 weeks.  Reversible
acetylcholinesterase inhibitor; by blocking some sites, may reduce symptoms.  No
CNS effects, as doesn't cross BBB.


Others not strictly chemical warfare agents:
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Riot Contrl Agents
Herbicides
Flame materials