Chemial Radiological Principles：化学辐射原理

1、chemical / radiological principleschemical terrorismchemical / radiological principlesobjectives learn how to perform a rapid assessment of a nerve agent terrorism situation. recognize characteristic signs and symptoms of nerve agent poisoning.chemical / radiological principlesobjectives understand

2、proper decontamination for nerve agent poisoning. learn medical management of nerve agent exposed victims. learn specific antidotes for nerve agent poisoning victims.chemical / radiological principles an unknown gas is released in the downtown rapid transit station. it is described as a thick mist,

3、and was found in 5 separate stops. thousands of commuters rapidly fled the stations to the streets. ems transport is overwhelmed, and several local eds are unable to absorb the patients presenting by ambulance, car, taxi, and on foot. many patients present to offices and local health departments.sce

4、nariofriday, january 31 8:47 am (rush hour)chemical / radiological principles one patient that presents to a local health clinic complains of tearing and runny nose. he also has mild shortness of breath. mild wheeze is noted on exam. ten other patients at the clinicare asymptomatic, but are very wor

5、ried.scenariofriday, january 31 10:02 amchemical / radiological principles public health officials confirm that the gas was sarin, similar to the toxin used in the subway of tokyo. scenariofriday, january 31 10:27 amchemical / radiological principles has your staff been adequately trained about chem

6、ical weapons? does your staff understand basic principles of decontamination? who should your staff alert? who will alert your staff in the event of a chemical terrorism event?things to considerchemical / radiological principlesnerve agentschemical / radiological principles liquids that disseminate

7、in the vapor/aerosolized form onset is abrupt (seconds to hours) designed to irritate, incapacitate, injure or kill predominantly inhalational and dermal threats if death occurs, usually respiratory causecharacteristics of nerve agentschemical / radiological principles chemical incidents are obvious

8、 shortly after exposure. biological agents will take days to cause symptoms. one patient can contaminate your facility first responders/health care providers are in the line of firecharacteristics of nerve agentschemical / radiological principles first used as a weapon during wwi most recent event -

9、 japanese subway incident in 1995 aum shinrikyo cult released sarin into 5 subway cars in downtown tokyo 12 deaths, hundreds injured, 5500 sought care 4,600 self-referred 135 first responders were injuredhistory of nerve agent weapons usechemical / radiological principlesshoko asaharachemical / radi

10、ological principlesnerve agentschemical / radiological principles military tabun (ga), sarin (gb), soman (gd), vx commercial parathion, sevin therapeutic drugs antilirium prostigmine mestinon general characteristicschemical / radiological principles effects of vapor - immediate wide range of symptom

11、s- affects sensitive organs of the face and respiratory system- over-stimulation of the central nervous systemgeneral characteristicschemical / radiological principlesnormal nerve functionchemical / radiological principlesnormal nerve functionchemical / radiological principlesnerve agent actionchemi

12、cal / radiological principlesslugbam: salivation lacrimation urination gi distress (nausea, vomiting, diarrhea) bronchorrhea (bradycardia, bronchospasm) abdominal cramps miosissigns and symptomsmuscarinic effectschemical / radiological principleshow bad is this stuff?vx ld50chemical / radiological p

13、rinciplessystemeffectskeletal musclestwitchingweaknessflacciditycardiovascularhrblood pressurecnsloc, seizuressigns and symptomsnicotinic effectschemical / radiological principlesexposuresymptomvery small dropsweatinglocal twitchsmall dropnauseavomitingdiarrheadroplocconvulsionsapneaflaccid paralysi

14、ssigns and symptomsdermal exposure effectschemical / radiological principlesexposuresymptomsmall amountmiosisslugbamsobchest tightnesslarge amountlocconvulsionsparalysisdeathsigns and symptomsvapor exposure effects3613204162signs and symptomseffect on pupil at x number of dayschemical / radiological

15、 principles clinical picture is key erythrocyte acetylcholinesterase activity level- amount of inhibition does not correlate with symptoms various electronic and “paper” detectors are available - for hazmat usediagnosischemical / radiological principlesgeneral patient managementchemical / radiologic

16、al principleschemical / radiological principles ppe (mask, gloves and protective suit) decontamination dont let your setting become contaminated abcs communicate with public health officials poison control center (800 222-1222) antidotes where appropriategeneral managementchemical / radiological pri

17、nciples soap and water hypochlorite solution 0.5% for skin 6 oz calcium hypochlorite in 5 gallons water 5.0% for equipment 48 oz calcium hypochlorite in 5 gallons waterprehospital managementchemical / radiological principles adult atropine dose: “enough” give atropine regardless of heart rate pediat

18、ric considerations 0.01mg/kg atropine used until endpoint achieved (resolution of secretions)treatmentchemical / radiological principles atropine - blocks the effects of neurotransmitter 2-pamcl (pralidoxime) - removes nerve agent from the enzyme military autoinjector mark iantidoteache2-pamclchemic

19、al / radiological principlesnamesynonymaging t1/2saringb 5 hourssomangd2 mintabunga40 hoursvxnone40 hours“aging”chemical / radiological principlesnerve agent questionschemical / radiological principleswhat was the public health lesson learned from the 1995 sarin terrorists attack in the subway system of tokyo, japan?a. this bioterrorist attack could only occur in a large city with an enclosed underground subway system.b. the walking wounded and hysterical patients often overload the medical system c. religious cults should be placed under strict federal surveillanced. ample s