Pediatric emergency medicine trisk 4557 4557
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CHEMICAL AGENTS
CLINICAL PEARLS AND PITFALLS
Chemical agents may secondarily affect first responders or medical
providers.
Providers must address airway, breathing, and circulation while
decontaminating the patient.
Removal of clothing is a simple and effective first step to
decontamination.
Nerve-agent poisoning can resemble cyanide poisoning in certain
ways, but nerve agents may have cholinergic symptoms.
Current Evidence
Mass casualties can result from the accidental or intentional release of either
traditional chemical warfare agents (CWAs) or toxic industrial chemicals. During
World War I, chemical agents such as chlorine, phosgene, and sulfur mustard
were used on an unprecedented scale. These agents are sometimes referred to as
first-generation chemical warfare agents. The second-generation chemical agents
are the G-series nerve agents, so called because Germany developed them before
and during World War II. After that war, structurally different kinds of nerve
agents were developed and were designated V-series nerve agents; these are thirdgeneration chemical agents. The G- and V-series nerve agents are also called
traditional nerve agents. Nerve agents, along with sulfur mustard, were used by
Iraq against Iran and against Kurdish villages in Iraq during the Iran–Iraq War of
the 1980s. In 1995, religious terrorists released sarin in the Tokyo subway system
and flooded the local medical system with casualties. Tragically, sarin was also
used in the Damascus suburb of Ghouta during the Syrian civil war in 2013,
killing more than 1,400 civilians, and weaponized chlorine has been used in the
same conflict as recently as 2018. Fourth-generation agents (FGAs) are one
category of so-called “nontraditional agents (NTAs)” investigated by certain
countries after the development of VX. Much information about the FGAs (and
other NTAs) remains classified. The FGAs include the A-series agents, or
Novichok compounds, which are low-volatility nerve agents even more persistent
than VX. One of the A agents was used in the 2018 assassination attempt on
Sergei Skripal in Salisbury, UK.
