see also: [[Disaster preparedness]], [[Radiation incidents]] - [Rosen WMDs](x-devonthink-item://97898371-F45F-4534-B3BE-F3ECF6F427EF) - [Review article: The nature of terror medicine EMA 2024](bookends://sonnysoftware.com/ref/DL/238687) # Disaster zones - hot zone - area immediately surrounding hazardous material - warm zone - area of decontamination btwn hot and cold zone - all personnel and patients must travser this zone from hot to cold - cold zone - does not require PPE - medical personnel usually only operate in this zone # Nuclear and radiologic devices > victims will suffer from three types of exposure: > 1. irradiation > 2. internal contamination > 3. external contamination - irradiated patents pose no threat to ED personnel - contaminated patients are more challenging, need early involvement of the radiation safety officer - externally contaminated victims have radioactive material on their skin or clothing and are decontaminated by removal of clothing and washing with soap and water *consider treatment with potassium iodide for radioactive iodine exposure* # Biologic weapons > three groups: > - Bacteria > - viruses > - toxins - dermal contact and ingestion are potential pathways for exposure - may have non-specific influenza-like illness > [!key points] prevent in-hospital transmission > - isolate patients in single room > - handwashing and PPE > - negative pressure if possible > - air filters > - alert hospital depts that generate aerosels ## anthrax - 2-10 days after exposure pts have influenza-like illness, malaise,fever, non-productive cough - abrupt deterioration wihth overwhelming sepsis, shock, haemorrhagic mediastinitis, dysponea, and stridor - CXR: widened mediastinum and hilar adenopathy - bloody pleural effusions can also occur - may seem like CAP **management:** - cipro or doxy if cutaneous without toxicity - cipro + linezolid or clinda if inhalational or has toxicity has toxicity - add meropenem if has meningitis ![[Pasted image 20240225003012.png| CT Chest of anthrax pt showing showing pulmonary consolidation and effusions]] ## smallpox > 3 major criteria: > - febrile prodrome 1-4 days prior to rash onset with headache, chills, vomiting, or abdo pain > - classic smallpox lesions deep seated, firm/hard, round well-circumscribed vesicles or pustules > - lesions in same stage of development > > 5 minor criteria: > - centrifugal distribution of lesions > - first lesiions on oral mucosal , face, or forearms > - pt appers toxic > - slow evolution of lesions from macule, to papule, to vesicle > - lesions on pals and soles # chemical weapons - symptoms manifest quickly > [!doses] ED preparedness for chemical WMDs > - community-based hospital coaltion planning > - personnel trained in recognition > - Mass casualty triage > - PPE > - access to antidotes, cyanide cits, anticonvulsants ## Nerve agents (sarin, tabun, soman, VX) - nerve agents are [[organophosphates]] - inhibit acetylcholinesterase, blocking degredation of Ach at postsynaptic membrane → overstimulation of muscarinic and nicotinic receptors - result in [[Cholinergic syndrome]] > - **bronchorrhoea, bronchospasm, bradycardia** > - bradycardia is rare > - [[miosis]] > - salivation > - lacrimation > - vomiting > - defication > - seizures, coma, aponea - **sarin** is liquid at room temperature but represens primarily a vapor threat because it is highly volitile - symptoms in seconds after inhalation - *Mild*: Rhinorrhea and miosis - *Moderate*: Mild symptoms plus increased secretions, wheezing or dyspnea, muscle weakness or fasciculations, or gastrointestinal effects - *Severe*: Apnea, seizures, loss of consciousness, flaccid paralysis, or major involvement of two organ systems - VX only a threat in liquid form ### management - decontamination of victims and remove clothing - showers - pretreatment with pyridostigmine prevents nerve agent binding - [[atropine]] for muscarinic effects (improved *ventilation*) - titrate dose to drying of respiratory secretions and not to HR or pupil size (indicated even in tachycardic patients) - [[Pralidoxime]] (2-PAM) for nicotinic effects (reverses *paralysis*) - diazepam for prevention and treatment of seizures > [!treatment] Treatment of nerve agent exposure > **vapor** > - mild: observe 1 hour, then release, no tx > - moderate: atropine 2-4mg IV repeat every 5-10 min as needed, and 2-PAM (*pralidoxime*) 1g IV during 30 minutes, repeat every hour as needed ## mustard gas - vesicants are blistering agents - sulfur mustard most likely was pt with copious water and dilute bleach solution or RSDL decontamination immediatly after exposure # Blast injuries Categories of blast injuries: | | description | | ---------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------- | | primary | barotrauma. hearing loss. "**blast lung**". unique to high-order explosives; results from impact of the over-pressurization wave with body surfaces | | secondary | results from *flying debris* and bomb fragments | | tertiary | results from individuals being thrown by the blast wind. can cause *head injuries* and *fractures*. | | quaternary | all explosion-related injuries, illnesses, or diseaases not due to the 1', 2', or 3' mechanisms (including exacerbations or complications of existing conditions) |