CBRN emergency preparedness

hematopoietic syndrome

- total body dose of 2.5-5 Gy death in 30-60 days - get prodromal syndrome and then a latent period where theyare symptom free - at ~3 wks, chills, fatigeu, petehiae, epilation - death due to infection (neutropenia), bleeding (thrombocytopenia), anemia secondary to bleeding but not b/c of decreased production

it's cyanide vapor is released

1. Wear your protective mask to. move to fresh air 3. provide an immediate support of care -secure airway, and intubate if necessary -obtain intravenous access and begin cardiac monitoring -correct significant acidemia (pH <7.15) by administration of sodium bicarbonate

cyanide detoxification regimen

1. crush amyl nitrite ampoule in gauze 2. place in nostril or bag valve mask bag 3. give 300 mg IV of sodium nitrite 4. inject slowly 5. immediately administer sodium thiosulfate IV 6. May tree again I up to half the original dose

two step cyanide detoxification

1. mitochondria with nitrites or hydroxocobalamin 2. the body with sodium thiosulfate

Anthrax

Bacillus anthracis contracted by handling hides, flush, or blood, ingesting products such as bone meal or contaminated meat, biological warfare dissemination resistant to UV light and environmental decay, May remain in the soil for many years

how does cyanide cause cell death in the body?

Interferes with anaerobic metabolism of the cell

a group of people is presenting with a delayed onset of blisters and a dry productive cough that later turns productive. what is the likely culprit?

Mustard

neutropenic

Pertaining to an abnormally small number of neutrophils in the blood (from radiation for example)

a patient is exhibiting the following symptoms of fever, cough, dyspnea, prominent gastrointestinal symptoms, absence of buboes. which form of plague is responsible?

Pneumonic

what bacterial disease produces a non specific illness that may produce a prolonged disability but is rarely fatal?

Q Fever

4 toxins likely to be used as bio-agents

Ricin Staphylococcal enterotoxin B (SEB) Botulism toxin T-2 Mycotoxins

Acute Radiation Syndrome (ARS)

Symptoms of short term radiation effects after a massive dose of ionizing radiation 3 subcategories hematopoietic gastrointestinal neurovascular

the amount of radiation in individual absorbs depends on three things

Time Distance Shielding

which type of nerve agent is most persistent?

VX

a patient presents to the hospital. he has been feeling ill since his return from Safari in Africa a few days ago. he exhibits symptoms of fever, mild hypotension, flushing, conjunctival injection, and now a bad rash has appeared that is bleeding in spots. what type of viral infection do you suspect?

Viral hemorrhagic fever

radiation Burns, which causes delayed, irreversible damage has of the skin, can be caused by high doses of what form of ionizing radiation?

beta

what method is used to estimate a radiation dose by measuring the biological response to and absorbed dose of ionizing radiation?

biodosimetry

what is used in life-threatening situations with the gold to remove contaminant as quickly as possible?

immediate decontamination

incubation period

interval between initial infection and first signs and symptoms

Pralidoxime Cl (2-PAM)

this oxime breaks the bond that attaches nerve agents to acetylcholinesterase. each auto-injector contains 600 milligrams, and after each of the first three atropine injections, a corresponding injection of 2 Pam chloride is given.

what type of decontamination is carried out by a unit to reduce contamination equal to natural background or to the lowest level possible?

thorough

treatment of the central compartment

treat local irritating effects of the skin and eyes early intubation warm, humidify. Oxygen aggressive pulmonary toilet bronchoscopy bronchodilators anti-inflammatory agents careful selection of antibiotics

types of tularemia

typhoidal type ulceroglandular type oropharyngeal type oculoglandular type pleuropulmonary type

ATNAA (Antidote Treatment Nerve Agent Auto injector)

used to treat cyanide exposure

decontamination should be conducted in the ___________ hazards zone

warm

cutaneous radiation syndrome

worsens prognosis, tx w/ anti-inflammatories and antimicrobials or surgical debridement and grafting will progress over time in stages

what illnesses is the mosquito a possible vector of?

yellow fever, Western equine encephalitis, dengue fever

assuming possible anthrax poisoning, what would be the most likely course of action with the presumptive diagnosis?

2 week course of cyprofloxacin

Prehospital care for nerve agents

3 auto injectors atropine sulfate, pralidoxime chloride (2-PAM chloride) diazepam

alpha particle

A cluster of 2 protons and 2 neutrons emitted from a nucleus in one type of radioactivity least penetrating

plague

Yersinia pestis can live in water, moist soil, dry sputum, flea feces, grains, buried bodies, near freezing temperatures dies after exposure to it's 55 degrees Celsius or sunlight

plague is detected by

a presumptive diagnosis identified from coccobacillus bacteria has a safety pin appearance can identify with immunofluorescence staining and fatty acid analysis diagnosis relies on cultures identify using enhanced chemiluminescence, enzyme-linked immunosorbent assay, polymerase chain reaction

Pyridostigmine bromide

a pretreatment for soman nerve agents. reversibly binds to 20% of acetylcholinesterase receptors, minimizing damage

a patient who works at an insecticide manufacturing plant is admitted to the emergency room. he states he was splashed with a large quantity of fluid and is now exhibiting symptoms of vomiting, diarrhea, difficulty breathing, body twitching and is generally very weak. what is the preferred treatment to block the effects of excessive ACH

administer additional 2-PAM Cl

what are the physical requirements of those expected to wear PPE?

agility, good physical condition, cardiovascular conditioning

Types of radiation

alpha, beta, neutron (particulate) photon (electromagnetic)

what are the three components, in correct order of administration, utilized in the treatment for cyanide exposure?

amyl nitrite, sodium nitrite, sodium thiosulfate

Brucellosis

an infection caused by brucella bacteria highly infectious via aerosol exposure low mortality rate

Bacterial Agents

anthrax, plague, tularemia, brucellosis, Q fever delivered as infectious aerosoft treated with antibiotics difficult to diagnose

diazepam

benzodiazepines increase the brain's seizure threshold

Atropine Sulfate

blocks effects of ACH at muscarinic receptors. administer up to 3 auto-injectors

anthrax is detectable by

blood augur cultures pleural and cerebrospinal fluid smears of mediastinal lymph nodes and spleen Immunoassays nasal swabs polymerase chain reaction (PCR)

ways to diagnose Q fever

chest radiographs presence of leukocytosis elevation of hepatic transaminase levels serological tests complement fixation test is most common

diagnosis of brucellosis may be determined by

chest x-rays, low leukocyte count, anemia and thrombocytopenia, blood cultures, bone marrow cultures, a biphasic culture method, a serum aguila tenacion test, ELISA, ESL, PCR

what industries are cyanide compounds widely used during?

classic production gold and silver extraction hide tanning

smallpox types

classic smallpox (variola major) milder disease (variola minor)

Q fever is caused by

contaminated aerosol inhalation, ingestion of contaminated dairy products

blank occurs when people come in direct contact with a harmful agent at or near an incident

contamination

what agent is fast-acting and attacks oxygen dependence tissues known to be particularly sensitive to these compounds?

cyanide compounds

damage to the respiratory tract

death of epithelial cells in the large airways obstruction of large airways fluid leakage from capillaries pulmonary edema recognize and treat the damage, not the agent!

a group of victims has been admitted to your triage unit. all victims have recently been in an area where canisters exploded spraying them with an amber colored liquid that smells like flowers and burns intensely. you suspect lewisite. what are the considerations during treatment of the victims?

decontaminate victims by washing, flush eyes for at least 5 minutes aggressive fluid management it's available, administer antidote BAL

patients with concurrent surgical injuries and radiation exposure should either be operated on expeditiously or ___________

delayed until past the time of bone marrow suppression and delayed wound healing

delayed/stochastic effects

effects of radiation-induced cancers taking up to 10 to 15 years or more to appear

Cyanide chloride (CK)

evaporates at a slower rate than AC. In high concentrations it can kill rapidly by paralyzing the respiratory system's nerve center

how is the victim of a pulmonary agent exposure presenting with respiratory distress less than 4 hours after exposure classified?

expectant

Beta particles are

fast moving electrons. 8,000 times faster than alpha particles. can cause burns Shielding materials: plastic, glass, light metals

Tularemia (rabbit/ deer fever)

francisella tularensis contracted from tissue contact, infected animals, insects buys, aerosol exposure resistant to freezing temperatures. killed by heat and disinfectants

photon radiation

gamma or xray radiation, from the electromagnetic spectrum potentially lethal, and often frequented with alpha and beta radiation shielding materials: Lead, concrete, earth

four types of anthrax

gastrointestinal inhalational injection cutaneous

q fever symptoms

headaches, fatigue, myalgia half of patients with pneumonia will exhibit non-productive cough or rails pleuritic chest pain occurs in about one-fourth of patients 33% of Q fever patients will develop acute hepatitis, with fever and abnormal liver function tests and the absence of pulmonary signs and symptoms

prompt/deterministic effect

high doses of radiation delivered to the whole body of healthy adults within a short. Of time produce effects such as blood component changes, fatigue, diarrhea, nausea, and death.

Variola major

highly virulent, caused toxemia, shock, and intravascular coagulation 30% fatality rate, but 3% fatality rate in immunized populations.

how is the victim of nerve agent exposure presenting with convulsions classified?

immediate

a patient was admitted to the hospital suffering from the following symptoms for the past five days. fever, malaise, fatigue, and non-productive cough. chest x-rays reveal a widened mediastinum and the patient white blood cell count is elevated. which type of anthrax is responsible for the patient's symptoms?

inhalational

pulmonary agent main targets

large airways small airways

neutron particle

large doses can kill a human shielding: concrete, water, polyethylene, oil

what phase is characterized by improvement of symptoms but becomes shorter with increasing doses?

latent

hydrogen cyanide (AC)

lethal vapor dispersed quickly

what level of civilian chemical equipment would healthcare providers don when providing initial medical treatment after an incident but not involved with decontamination?

level C

what are the symptoms for ingested cyanide?

metallic taste in mouth, epigastric distress, and possible nausea and vomiting

the primary toxicity of pulmonary agents is to the ____________ and follows ___________ of smoke, articles, vapors, or gases

mucous membranes, inhalation

vesicant blister agents include all of the following

nitrogen mustard lewisite phosgene oxime

choking agents contain

phosgene (CG) chlorine (CL)

what form of ionizing radiation can penetrate deeply into body tissue?

photon

chemical agents categories

physical state physiological effects use

your unit has responded within minutes to a suspected seaburn incident. select the important steps that you should take

practice protective measures of time, distance, and shielding

Cyanide agent

prevents diffusion of O2 to cells

ARS four phases

prodromal phase. symptoms will include burning sensations of the skin, extreme nervousness, and confusion. May include severe nausea, vomiting, watery diarrhea, loss of coordination of muscular movement, respiratory distress, disorientation, lapses in consciousness, and convulsive seizures. symptoms May last from several minutes to several hours Latent phase. it is possible for a victim to regain some functionality for a very brief time, at the most several hours manifest phase. within 6 hours of initial exposure, the victim will become disoriented, lose the coordination of muscular movement, and suffer respiratory distress, diarrhea, convulsive seizures, coma, and finally death. recovery phase. circulatory complications such as cerebral edema and increased intracranial pressure can bring death within 2 days

prophylactic treatment of radiation exposure

protactinium iodide Prussian Blue (PB) (ferric hexacyanoferr DTPA Radioprotectants Androstenediol Filgtastim

chemical agent categories

pulmonary agents cyanide agents Nerve agents vesicant agents incapacitating agents riot control agents

lewisite shock

pulmonary edema and hypotension in results to lewisite vesicant agent exposure

what should treatment of patients suffering from pulmonary agent exposure focus on?

recognizing which compartments are damaged and minimizing that damage

what are properties described by spores produced by bacillus anthracis, causative agent of anthrax?

remains viable in soil for years resistant to environmental decay can be found in animal hides

what decontamination methods are recommended for removing vesicants from casualties?

remove patients clothing, ensure agent does not contact skin during removal use a stick to remove large globs of agent off the skin. use the M291 decontamination kit to absorb the agent

pulmonary agent signs and symptoms

shortness of breath difficulty breathing sudden laryngeal spasms pulmonary edema vomiting abnormally low blood pressure possible death

a patient presents with five day old blisters/rash mostly on the arm, face, and hands. no scabs are present. patient reports fever started several days before blisters appear. based on the information would you suspect chickenpox or smallpox?

smallpox, because the rash is centrifugal on the patient

potential viral bio agents

smallpox, encephalitis viruses, hemorrhagic fever viruses

processed foods and temperature abused foods are most commonly associated with _______ poisoning

staphylococcal enterotoxin B (SEB)

a patient presents to the emergency room all exhibiting the following symptoms. nausea, vomiting, problems with eye movement, dry mouth, sore throat, difficulty swallowing, no gag reflex, and extreme weakness. patient is alert and oriented during the exam. what toxin do you suspect and how do you treat it?

staphylococcal enterotoxin B, supportive care and observe for pulmonary edema

a patient has a scab what is your course of action for this patient?

swap the area under the scab and of the area under the vesicle without cleansing the skin first

symptoms of cyanide

tachypnia and tachycardia dizziness headache vomiting weakness and restlessness rapid deep breathing loss of consciousness convulsions respiratory failure cardiac arrest death