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The main ideas from this information are: - Different agents enter the body in different ways (respiratory tract or skin). - Vesicant agents like sulfur mustard cause blisters and can be inhaled, leading to blisters in the airways. - Anthrax is a bacterial agent and occurs naturally in certain parts of the world. - Exposure to vesicant agents can cause skin irritation and burning. - Chemical agents are designed to debilitate the enemy and cause intense pain and blisters. - Pulmonary agents like chlorine gas can cause upper airway irritation and pulmonary edema. - Nerve agents have different types but have similar effects on the body. - Hydrogen cyanide affects the body's ability to use oxygen and is found in industrial settings. - Treatment for cyanide exposure includes high flow oxygen and specific medications. - Biological agents can be difficult to detect and cause flu-like symptoms. Overall, the information covers different types of chemical agents and their effects on the body, as A lot of those are gas agents and things where they kind of disseminate very quickly, disperse quickly. Rune of exposure is how the agent most effectively enters the body. Agents with a vapor hazard enter through the respiratory tract, agents with a contact skin hazard give off very little or no vapor but enter the body through the skin. There are some chemicals like sulfur, mustard, mustard gas, which was used in World War II, that actually give off a vapor too. So it's a blister agent, we call it a vesicant, it causes blisters, but patients breathe it in and then it causes blisters in their airways, which obviously leads to death. Like anthrax? Anthrax is a bacterial, it's a biological agent. Oh. And there is, anthrax is a bacterial, just like tuberculosis, it's only more, it has more pathologic. I'm just going to say about the anthrax things that you said after 9-11. Yeah, that's a chemical agent. Anthrax is a naturally occurring, there are people that are immune to it, farmers. Anthrax occurs in soil of certain parts of the world and people get it, they're exposed to it and they have an immunity to it. So vesicant, primary rune is the skin, if a vesicant are left on the skin long enough they produce vapors that can enter the respiratory tract like sulfur, mustard, it's designed for that. Burn-like blisters on the skin and the respiratory tract usually cause the most damage to moist, damp areas under the arms, the groin, the feet, in the mouth, in the airway, in the ears, in the eyes. Sign of vesicant exposure means skin irritation, burning and redness and it's severe debilitating burning. The point of a chemical or vesicant agent is to stop your enemy in its tracks, to debilitate your enemy to where it can't fight anymore. That's the whole point of every chemical weapon, every nuclear biological chemical to stop the enemy. Immediate intense pain, formation of large blisters, gray discoloration of the skin, your eyes will swell shut, your mute super amount of secretions in your nose and your mouth as you're trying to fight this, permanent eye damage including blindness. Sulfur mustard is a brown, yellowy, oily substance. It's very persistent because it's oily. It begins an irreversible process of damage to the cells. It actually causes cellular damage. It breaks down the DNA and damages the cells. In World War II this was used. They actually tested this on African Americans. They took African American soldiers and tested sulfur mustard because they felt with their dark skin, they had a greater resistance to it. They were wrong and it wasn't just until the last 15 years where they actually compensated family members for this. 15 years. Some of the things that we did. Attacks vulnerable cells in the bone area, depletes the body's ability to reproduce white blood cells. So it causes all kinds of conditions. Skin cancers and eczema and scleroderma and autoimmune disorders. And then the vapors can be inhaled creating upper and lower airway compromise. Leucite and phosgene oxime produce blister wounds very similar to those caused by mustard but it's immediate. And the patient may have great discoloration on the contaminated site. Leucite, especially phosgene oxime, that's produced in burning certain chemicals. Chemical burns can actually produce this. No antidotes for sulfur mustard or CX exposure. Basically it's a burn. You're treated in a burn center. You would go to a burn center like Shriners Burn Center for that. So the patient has been decontaminated because that chemical will off gas on you. Make sure they're cleaned and decontaminated before you get them. If the agent has been inhaled, the patient requires prompt airway support. They're going to have to be suctioned. They're probably going to have to be sedated and intubated. Probably going to have to have RSI because the airway is going to swell with those blisters and they'll lose their airway. Initiate transport as soon as possible. Burn centers. Most patients who have these severe chemical burns end up dying from infections. Pulmonary agents, gases that cause immediate harm to the person who is exposed to them. It's through the respiratory tract. Pulmonary edema results in literally drowning in your own fluids in the lungs by impaired gas exchanges. The first one used was chlorine gas during World War II. They had these canisters they would throw into or shoot into the opposing trenches. And then they used the chlorine gas and they used... I know phosgene has been used as well. But phosgene can also be a pulmonary agent. Chlorine, again, the first chemical ever used initially, produces upper airway irritation and choking sensation, shortness of breath, tightness in the chest, hoarse voice, gasping and pulmonary edema. If you ever clean your bathroom with bleach and forget to open the window and turn on the fan and all of a sudden you get that burning and raspy throat, imagine that times a thousand. And that's the chlorine gas. Phosgene, here it is, phosgene. Production of combustion, very potent agent, and delays. This is a delayed onset of symptoms. You don't get this now. You get it 15 minutes from now. Which means because of the delayed exposure, you spend more time in it. Whereas like chlorine gas, the moment you're exposed, whereas phosgene has a little delay so you get exposed more. It has a higher infection, right? What's that? It has a higher infection. Infection? That's not an infection, it's a chemical. It's not, it's like inhaling. Yeah, it's a chemical. Nausea, tightness in the chest, severe cough, dyspnea, and pulmonary edema. Pulmonary agents, remove the patient from the contaminated atmosphere. Get them out. Fresh air, high flow oxygen. Manage the ABCs aggressively. Make sure you're not exposed to that. Don't worry, it's not like they're gonna off gas you. They're not gonna cough it out at you. Manage ABCs aggressively. Suction, do not allow the patient to be active. There are no antidotes because it's a dangerous to the lungs. It causes damage in pulmonary edema. They're gonna need probably bronchoscopy, high doses of diuretics. Probably end up intubated. Call ALS. Miramage is among the most deadly chemicals developed. Can cause cardiac arrest within seconds to minutes of exposure. Organophosphates are the most common. These are the household bug sprays and pesticides. And again, they do one of two things. They stimulate acetylcholine, which causes the parasympathetic response. Feed, breed, or sleep and you drown in your own pools. Bradycardia, hypotension. Or some of the chemicals shut off acetylcholinesterase, which removes acetylcholine from the nerve synapses. Which leaves acetylcholine on longer, which again, causes the same symptoms. These are common nerve agents. Now, we're gonna talk about These are common nerve agents. Now, if you're close enough to know the difference between TAVEN and SARIN, you're dead. If you're close enough to identify the type of smell or how the patient is being exposed, you're probably dead. So why do they put that there? I don't know why you need to learn this. Do I have to know the difference between I don't think so. But anyway. Table 41-2 Go ahead and read through it. Be familiar with it. I'm not gonna review it because I think it's stupid. You're never gonna know the difference. Nerve agent is a nerve agent is a nerve agent. It's gonna do the same thing to me. I don't care if it's TAVEN or SARIN. It's gonna kill me. They're not gonna ask us if it's smelling or not. Smell this. You know what I mean. No, they won't ask you what does it smell like. No, they won't. So, sludge and dumbbells. We covered these. Make sure you're familiar with them. You might see this again. We talked about these. The DUODOTE is the most common one now. DUODOTE is the atropine and butane chloride called polyoxymethyl chloride. The atropine stops the parasympathetic reaction and the butane chloride drives up secretions. Hydrogen cyanide and cyanogen chloride affect the body's ability to use oxygen. This is a metabolic agent. What it does is it interferes with the metabolism of oxygen in the cells. Immediately shutting down the cell's ability to metabolize oxygen. It's found in industrial settings. As a matter of fact, in Millbury, there's a company, it's found in plastics manufacturing. Metal electroplating. There's a company in Millbury that uses it. They're trying to find other alternative chemicals to use because of the danger of cyanide. Right now, they still use it. I told you about it. The treatment is hydroxycobalamin which is vitamin B12. It's massive doses, like grams by IV delivered. It's like $1,000 a dose. They actually bought it for us to carry it because we're not going to buy it. That's the treatment for it. Associated with lightness, dizziness, lightheadedness, headache, vomiting, coughing, shortness of breath. You might get rapid unresponsiveness to cardiac arrest. It smells like almonds. You'll have a strong almondy smell. Stick your face in a bag of regular almonds and smell that. If you smell that in the air, that's the potential for cyanide. High doses, again, shortness of breath, gasping respirations, respiratory distress, trachea, skin, tachycardia, ultimate mental status, seizure coma death. Cyanide treatment, again, get them out of the environment. High flow oxygen. That's one of the antidotes. High flow oxygen and clean air. Call ALS. There's a couple of different treatments you can use. Ammonitrate, sodium thiosulfate. Those are both very expensive, but they have a high organ damage. They have a a, what do they call it, a therapeutic threshold. They have a narrow therapeutic threshold for what treatment and what actually causes you to do. So, hydroxychloroquine is the most common one. Biological agents can almost be completely undetectable. Diseases caused by similar diseases will be similar to other diseases. Almost like flu-like symptoms. When you run through them, you'll see that most of them will produce flu-like symptoms. I remember, anybody like Stephen King? Anybody ever read The Stand? I have that book. I haven't yet. Oh, you've got to read it. Read it or watch the book. But you've got to see it. It's an awesome book. I'm not going to give it away. The whole movie starts out with an illness. They call it Captain Trish. It's a chemical, biological agent used by the U.S. military. A guy breaks out of the U.S. military. He's a worker. He gets sick. He breaks out. He runs out. He passes with a sneeze. It's like you're in an airplane or you're in a theater or you're here and somebody sneezes and all of a sudden what is it called? The Stand. It's actually a good versus evil, god versus devil. So there's two parts to it. The first part is when the world kind of ends because of it and the second part is how the good is against the bad. So it's really a good book. It's a thick book. Yes! And they did it twice. The first one was with Gary Sinise. That was back in the late 80s, early 90s and then they just made a remake of it. The early one I think is better. But anyway, I digress. So biological agents can cause many minor illnesses to start out with flu-like symptoms. It can be spread by various ways. Dissemination is the way in which it spreads. A disease vector is an animal that spreads disease to another animal. This is something that we've seen. Mice carry the fleas and the fleas carry bubonic and pneumonic plague. Ticks carry Rocky Mountain spotted fever or they carry Lyme disease, right? Or rats can carry Hantavirus. Hantavirus is a what they call a hemorrhagic virus, hemorrhagic fever. How easily disease is spread from one human to another is called its communicability. What is the most communicable virus on the planet? I don't know. COVID. Intubation period is the period of time between when a person becomes exposed and the first time the symptoms can appear. This is the problem. With many of your viruses like the flu, like cold, like COVID, during its incubation phase I feel fine but I can get sick. Hey, how are you doing? Nice to meet you. Alright, touch the door now. If somebody comes up, touch the door now, rub their eyes. That's it, you got it, right? Germs or viruses, oh, by the way, that's one of the reasons why and there's no I don't think they've ever proven it but that's one of the reasons why you'll always find trash barrels near the door of a bathroom because you're supposed to wash your hands and then use the towel to open the doorknob. The dirtiest parts of any bathroom are the doorknob and the sink. Do you know the area of the ambulance that has the highest concentration of bacteria and viruses? And the coffee holder, the cup holder, steering wheel and the cup holder are the two dirtiest parts of any ambulance. So if you're one of those that likes to eat and drive at the same time, don't do that. Viruses are germs that require a living host to multiply and survive. Unlike bacteria, bacteria are free-flowing, they're self-contained, they're living organisms. Viruses are just kind of genetic material that have to get into other cells to replicate. That's why bacteria are far worse because bacteria are their own living hosts. Invades cells and replicates and spreads through the host, moves from host to host by direct message or through vectors. So this is smallpox. Smallpox is highly contagious although it was almost eradicated in the United States. It was eradicated in the United States but it is in other countries. You cannot get it if the patient coughs on you, it's not aerosolized. But you get it by touching those vesicles or coming in contact with secretions blood, saliva, mucus from the patient. And the problem with this is it looks like chickenpox. It's not a chickenpox even though it looks like it. It's far worse but it also causes organ damage. That's the problem. This is different from chickenpox because chickenpox is outside, it kind of makes you sick. This actually causes damage to the organs. So it's disseminated aerosolized for warfare or terrorism use. Aerosolized means they put the spray in the air. You can't, I can't cough it on you. Communicability is high for infected patients or contaminants. Person to person transmission is possible. If you touch the the erudate is that what they call it? The what? The pox. Inhalation of cough droplets or direct contact with the blisters. You can't really you can't get it from the cough droplets but if the patient has sores in their mouth and they cough it you can breathe in the droplets. Severe fever, malaise, body aches, headaches, small blisters. The treatment is basically supportive. There is no specific treatment. If it's caught early enough you can get the vaccine which will lessen the symptoms if you catch it early enough. Viral hemorrhagic fever. Things like Ebola, Dengue, Hunter, Rocky Mountain spotted fever. What happens is they produce they produce a high fever but they produce chemical changes in the body that cause the blood vessels to become more permeable and leak. They dilate more permeable and you lose blood and that's why you bleed from all your orifices. Your eyes, your ears, your nose. They say that your organs turn to jelly or mush. No they don't. But you bleed from especially organs that are highly vascular like the liver, like the spleen. Patients will start out with flu-like symptoms but progress more seriously and have internal hemorrhage. Very few people in the United States die from a viral hemorrhagic fever because we have antiretrovirals, we have viral medications and we have IV fluid. Patients die from viral hemorrhagic fever because they become hypovolemic. We can stop that. We can transfuse patients, we can give them IV fluid and we can give them an antivirus. That's why people don't die of these in the United States. These very small numbers of people. If you go in Africa, tens of thousands of people die a year from this and it's mostly in rural areas where it can take two or three hours to get to a clinic. Direct contact with infected body fluids can be aerosolized, moderate from person to person, communicability. Direct contact with infected bodily fluids. It's not coughed on you. You have to physically get in contact with it. Sudden onset of fever, weakness, muscle pain, headache, sore throat and it can lead to seizure coma death. Basically supportive care, IV fluids, blood products, antivirals. That would be the treatment. Bacteria do not require a host to multiply and live and can be a hundred times larger than a virus. Most can be fought with antibiotics. Does anybody know what antibiotics do to a bacteria? How does it work? Does it make it go dormant or something like that? It doesn't make it go dormant. Alcohol does the same thing. It denatures the cellular wall causing the bacteria to lyse or break open. If a cell lyses, they call it the lyse, if a cell lyses it breaks open and it kills it and that's what antibiotics do. They destroy the cellular wall. The problem with antibiotics is it can destroy bacteria that are bad. It can also destroy good bacteria. That's the problem with antibiotics. We'll generally begin, again, look at the look at the how would you say the reoccurring theme here. Flu-like symptoms. Flu-like symptoms. Anthrax. Anthrax. Anthrax is spore-like bacteria that can survive. Actually on Bikini Atoll, which is a place out in the South Pacific where we tested nuclear weapons, they still have anthrax on that island. It's irradiated and they still have anthrax in the soil. Anthrax is very volatile. It's very non-volatile. Unlike tuberculosis, which is the same spore-like bacteria ultraviolet light and warmth kill TB. It won't kill anthrax. Anthrax is caused by bacteria that's typically dormant in spores until it gets to a warm, moist place and it works up. You can get cutaneous and GI anthrax. That's not life-threatening, although it's very uncomfortable. The life- threatening is inhalation anthrax. You get it in your lungs. That's what's going to do. Antibiotics can be used. Cipro. That's where Cipro came about. Cipro is a broad-spectrum high-potency antibacterial. And a vaccine is also available. Dissemination is aerosolized. Communicability, only in acute caneus form. Once I get it, unlike tuberculosis, where I can cough it out and give it to you, here you can. Flu-like symptoms, fever, respiratory distress, tachycardia, pulmonary edema. You can actually confuse this for tuberculosis, but this is far more dangerous and far more deadly. The plague. Bubonic and pneumonic. Bubonic produces these buboes, or inflammation, within the lymph glands, lymph nodes. Pneumonic plague is in the lungs. Obviously, pneumonic plague is far more deadly. This is what killed 30 million Europeans during the Black Plague, during the Middle Ages. That is where the nursery rhymes. Bring around the rosy. They used to say, bring around the rosy, because it used to cause a ring-like rosy rash. Pockets full of posies. They used to say that carrying flowers watered off the illness. Ashes, ashes. They used to burn the bodies in the street. They all fall down. So, when kids are saying, bring around the rosy, they are saying about the Black Plague. What's that? Yeah. Those nursery rhymes come from very dark places. Yeah. So, there's the buboes right there. Sometimes they can actually rupture. Basically, you can end up with infections or this can convert to pneumonic plague. So, aerosolized bubonic is very low, but pneumonic is high because it's knee-cost. Right? If you catch it. Fever, headache, muscle pain, tenderness, pneumonia, shortness of breath, hemoglobin, lymph nodes. Basically, you're going to treat this. Antibiotics can treat it. You're going to just support it, care, and transport it. Neurotoxins, the most deadly substance known to humans, is produced by plants, green animals, molds, and bacteria. We kind of touched on this already. Roots of injury are ingesting, inhalation, or injection. Not contagious, and have a faster onset of symptoms. They're very rapid onset, and you're not going to get it as long as you're not exposed to it itself. Botulism. We talked about this. Botox. Botulin toxin. And it's very easy to produce this in a lab, in a garage, and then I walk by a salad bar at a grocery store or at Wendy's, and I just sprinkle it as I walk by and I walk out. And now 75 people or 100 people have botulism. It's not difficult to spread it. It affects the central nervous system, and if there is an antidote to it, and we can test for it in the blood, give it the antidote, and you're fine. As long as it's caught in time. But this causes respiratory paralysis. People die because they suffocate.