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CHEMICAL TERRORISM

CHEMICAL TERRORISM. OBJECTIVES. Through this activity the student will: Learn how to perform rapid assessment of a cyanide agent terrorism situation. Recognize characteristic signs and symptoms of cyanide poisoning. OBJECTIVES. Know proper decontamination for cyanide poisoning

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CHEMICAL TERRORISM

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  1. CHEMICAL TERRORISM

  2. OBJECTIVES Through this activity the student will: • Learn how to perform rapid assessment of a cyanide agent terrorism situation. • Recognize characteristic signs and symptoms of cyanide poisoning.

  3. OBJECTIVES • Know proper decontamination for cyanide poisoning • Learn how to medically manage cyanide exposed victims. • Learn specific antidotes for cyanide poisoning.

  4. CASE SCENARIO • You are part of the hazmat team that is called to respond to a possible terrorist attack in an art museum where the terrorists spilled “blue crystals” on the gallery floor and poured “some kind of liquid on them”.

  5. CASE SCENARIO (Continued) • As fumes developed, several people started choking and collapsing. The museum authorities tell you 120 people are already pronounced dead at the scene. You noted a musty bitter almond odor when you enter the gallery.

  6. What is the poison?

  7. Cyanide Poisoning

  8. Cyanide • Common chemical • Rapidly acting • “Blood Agents” is a misnomer • No direct effect in blood

  9. Where is cyanide found?

  10. Cyanide • Occurs naturally in foods (some fruits, lima beans) • Cyanide salts used in industry (e.g. ore extraction) • Produced in smoke of burning plastics/synthetics • Electroplating • Metal polishing • Smells like “bitter almonds”

  11. What is the cellular mechanism of cyanide poisoning?

  12. Mechanism of action of Cyanide • Inhibits cellular respiration • Cytochrome a-a3 • Tissues cannot utilize oxygen • “Arterialization of venous blood”

  13. Kreb’s cycle and Cyanide

  14. What are the clinical effects of cyanide?

  15. Clinical Effects of Cyanide • CNS • Headache • Dizziness • Seizures • Coma • Cardiovascular • Hypertension, bradycardia • Hypotension, later in course • Cardiovascular collapse

  16. Clinical Effects of Cyanide • Pulmonary • Dyspnea • Tachypnea • Pulmonary edema • Apnea • Gastrointestinal • Nausea, vomiting • Caustic effects

  17. What diagnostic studies are used to detect cyanide poisoning?

  18. Cyanide Diagnosis • Clinical picture • Lactic acidosis • ABG: • metabolic acidosis ABG sample

  19. ABG Findings

  20. When has cyanide been used historically as a potential weapon of mass destruction?

  21. Cyanide Weaponization • WWII – Nazi Concentration Camps • Jonestown Massacre • Found in Tokyo subway restroom after Sarin release • Chicago subway in 2002

  22. Is there an antidote for cyanide poisoning?

  23. Treatment • Remove from source • Oxygen • Cyanide antidote kit • Cyanide kit causes methemoglobinemia

  24. Cyanide Antidote Kit • Amyl nitrite perle until IV established • Sodium Nitrite (300mg IV) • Peds: 0.33 ml/kg of 10% solution) • Sodium Thiosulfate (12.5gm IV) • Peds: 1.65 ml/kg of 25% solution) Cyanide antidote kit

  25. Cyanide Poisoning Questions?

  26. Question #1 • Cyanide poisoning may have a characteristic smell of which of the following? • apricots • bitter almonds • garlic • freshly mown hay • plastic

  27. Question #2 Which of the following is most correct regarding the cellular mechanism of cyanide? • Cyanide poisoning promotes oxygen utilization and adenosine triphosphate (ATP) production. • Tissues are able to metabolize excessive amounts of oxygen • Causes a profound cellular alkalosis • Diminishes levels of cellular lactic acid • Inhibits cellular respiration at cytochrome a-a3

  28. Question #3 Scenario: You are a healthcare provider visiting an art museum when a security guard calls out “we have a healthcare emergency!” You find out that terrorists spilled “blue crystals” on the gallery floor and poured “some kind of liquid on them”. As fumes developed, several people started choking and collapsing. The museum authorities tell you 120 people are already pronounced dead at the scene. You note a musty bitter almond odor when you enter the gallery.

  29. Question #3 (Continued) • What do you do? • Go in and perform CPR on victims • Attempt to rescue survivors • Notify proper authorities and leave the area immediately • Enter the gallery and open the windows to ventilate area

  30. When the hazmat team arrives, what do you do? Question #4 • Stay out of the way • Request appropriate gear and join the rescue effort • Assist in triage within the contaminated area • Continue touring museum

  31. What is the best combination of antidotes to give any symptomatic survivor? Question #5 • Sodium nitroprusside / Vitamin B12 • Sodium nitrite / Sodium thiosulfate • Atropine / Pralidoxime • Dimercaprol (BAL) / Calcium EDTA

  32. This ends the current presentation

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