injuries poisoning
Nerve Chemical Warfare Agents
Symptoms and Signs of Nerve Chemical Warfare Injuries
The clinical manifestations depend on the state of the agent, route of exposure, and dose. Vapor exposure to the face causes local effects such as miosis, rhinorrhea, and bronchoconstriction within seconds, progressing to the full range of systemic manifestations of cholinergic excess. However, inhaled vapor causes collapse within seconds. Liquid exposure to the skin first causes local effects (local twitching, fasciculations, sweating). Systemic effects occur after a latent period that can be as long as 18 hours after exposure to a very small droplet of a G- or V-series nerve agent; even fatal doses usually take up to 20 to 30 minutes to cause symptoms and signs, which may include sudden collapse and convulsions without warning. Skin exposure to a liquid A-series agent has a latent period ranging from hours to a day or two. Patients exhibit parts or all of the cholinergic toxidrome, or cholinergic crisis (see tables Common Toxic Syndromes and Long-term neurologic and neurobehavioral effects also may occur and include a syndrome that has been called chronic organophosphate-induced neuropsychiatric disorder and organophosphorus-ester–induced chronic neuropathy. 