Pediatric emergency medicine trisk 4575 4575
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FIGURE 132.8 A patient with mustard-induced skin blisters. (Reprinted with permission from
Greenberg MI. Greenberg’s Text-Atlas of Emergency Medicine . Philadelphia, PA: Lippincott
Williams & Wilkins; 2005:968.)
Vapor exposure results in later, and usually milder, skin injury. Ocular lesions
from vapor include conjunctival inflammation and corneal damage. Permanent
blindness is a rare complication, but many patients presenting for treatment may
be functionally blind from pain and blepharospasm. Vapor-induced pulmonary
effects begin, typically after a delay of 1 to several hours, with upper respiratory
tract irritation and may progress through dyspnea and a productive cough to a
severe necrotizing tracheobronchitis with pseudomembrane formation. Patients
may succumb to secondary bacterial bronchopneumonia. Bone marrow damage
may occur in severe cases on about the third to fifth day after exposure and
manifest as progressive pancytopenia. Leukocyte counts less than 500/mm3 or
precipitous decreases in the leukocyte count portend a serious risk of sepsis and
death.
Experience with children exposed to vesicants is limited. An accident
involving the explosion of a mustard-containing shell caused a heavy exposure to
three children. These patients presented acutely with altered mental status, and
two of them died 3 to 4 hours after exposure. A case series of Iranian children and
adolescents exposed to mustard during the Iraq–Iran War found that they
exhibited a shorter onset and more severe dermal lesions compared with adults.
