injuries poisoning
Pulmonary Chemical Warfare Agents
Treatment of Pulmonary Chemical Warfare Injuries
Supportive care For type 1: Early intubation and bronchodilators, sometimes inhaled corticosteroids, and antibiotics for documented secondary bacterial infection For type 2: Oxygen and positive-pressure ventilation (continuous positive airway pressure in conscious patients; positive end-expiratory pressure in ventilated patients), bronchodilators, and rarely corticosteroids It is important to treat the damage rather than the agent because some agents cause both type 1 and type 2 effects even at low doses, and high doses of either agent cause both types of damage. Decontamination of vapor or gas exposure is not indicated, and there are no specific antidotes for these agents. give warm, humidified 100% oxygen by face mask. Bronchoscopy may be both diagnostic and therapeutic, via the removal of necrotic debris from the large airways. Early intubation and assisted ventilation may be needed. Bronchodilators may help by increasing the caliber of airways. Inhaled corticosteroids may decrease the inflammation that often accompanies large-airway damage. For management of smoke inhalation, see Smoke Inhalation . patients should be admitted to an intensive care unit (ICU). Oxygen should be given via continuous positive airway pressure (CPAP) in conscious patients or via positive end-expiratory pressure (PEEP) in intubated patients. Positive-pressure ventilation may help force fluid from the alveolar spaces back into the pulmonary capillaries (see also Treatment ). A central line may help monitor pulmonary pressures so that they can be controlled without inducing hypovolemic shock. Although bronchodilators are indicated mainly to dilate large airways in cases of type 1 damage, recent evidence suggests that they act via independent pathways to alleviate type 2 damage as well. Corticosteroids do not relieve pulmonary edema but oral corticosteroids may be indicated early for patients exposed to HC smoke or to oxides of nitrogen in an effort to prevent late-onset pulmonary fibrosis. Prophylactic antibiotics do not help either type of injury. Antibiotics should be given only after diagnosis of bacterial infection is made, including isolating an organism and determining antibiotic sensitivities. The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, or the US Government. 