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Additional resources for Hospital Emergency Response Teams. Triage for Optimal Disaster Response
They may also complain of other more nonspecific symptoms such as muscle aches, fatigue, nausea, vomiting, abdominal pain, and malaise. As symptoms progress, more significant respiratory complaints develop, and patients may become significantly short of breath with complaints of air hunger (hypoxia). This is often the point at which they seek medical care. The pulmonary form of anthrax results from inhalation of aerosolized anthrax spores and is the most severe clinical form of the disease. The median incubation period in the 2001 bioterrorism-related cases in the United States from known times of exposure in six cases was 4 days (range 4–6).
Although diazepam is most commonly recommended, other benzodiazepines can be used if diazepam is not available, as might be the case in a mass casualty incident. Decontamination is a critical step in the care of nerve agent victims. Continued absorption of agent will significantly undermine the effectiveness of advanced life support measures and/or antidotes administered to nerve agent poisoning victims. Therefore, treatment plans and protocols should provide for decontamination taking place as early as possible.
Nicotinic manifestations of nerve agent poisoning are primarily the result of excess acetylcholine at the neuromuscular junction causing skeletal muscle fasciculations followed by weakness and eventually paralysis. Diaphoresis can also be seen as a result of excessive cholinergic tone at the autonomic ganglia of sweat glands. As mentioned above, the respiratory system is the site of the most serious acute clinical manifestations of nerve agent poisoning. The direct effects of the nerve Chapter 2 • Assessment of Likely Mass Casualty Events 41 agent on the respiratory tract (bronchorrhea and bronchoconstriction), inhibition of the CNS medullary respiratory center and paralysis of the diaphragm and skeletal muscles associated with respiration (Rickett, 1986; Wright, 1954) combine to cause respiratory failure.