Bioterrorism Handouts

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   Prepared by: John Eric D. Rosales, RN, RM, MAN Lecture Notes for Acute Biologic Crisis Bioterrorism handouts BIOTERRORISM Common routes of Entry:    Inhalation: vapor, aerosol, solid    Absorption: liquid, vapor, solid    Ingestion: solid, liquid    Injection: liquid Chemical agents are available and well-known, can cause major injury and death, and result in panic and social disruption. These include nerve agents, vesicants, blood agents, and pulmonary agents. Nerve agents Nerve agents include:    organic phosphorus pesticides    carbamate pesticides    sarin    soman    tabun    VX Nerve agents are odorless, colorless, and volatile liquids in their pure form. They are absorbed through the mucous membranes by inhalation and through the skin. VX is an oily liquid that is absorbed through the skin. The time it takes to produce symptoms is seconds to minutes if inhaled, and minutes to hours if absorbed through the skin. CAUSES WHY? Prevents proper functioning of Inhibits acetylcholinesterase production, nervous system enzyme responsible for breakdown of neurotransmitter acetycholine Hyperexcitability of nervous Agents bond with acetylcholinesterase, system so that acetylcholine is not removed; the accumulation of the excitatory neurotransmitter acetylcholine in both the peripheral nervous system and the central nervous system (CNS) occurs SIGNS AND SYMPTOMS WHY Miosis (pinpoint pupils) Parasympathetic overactivity Visual disturbances Parasympathetic overactivity   Prepared by: John Eric D. Rosales, RN, RM, MAN Lecture Notes for Acute Biologic Crisis Bioterrorism handouts Increased GI motility Increase in parasympathetic tone; overstimulates digestive secretions Nausea and vomiting Increase in parasympathetic tone; overstimulates digestive secretions Diarrhea Increase in parasympathetic tone; overstimulates colonic activity Substernal spasm Parasympathetic overactivity Indigestion Parasympathetic overactivity; overstimulates GI secretions Rhinorrhea (runny nose) Parasympathetic overactivity Salivation Increase in parasympathetic tone; overstimulates salivary glands Bronchospasm/laryngeal spasm Parasympathetic overactivity Bradycardia Parasympathetic overactivity Atrioventricular block Parasympathetic overactivity Lacrimation Increase in parasympathetic tone; overstimulates tear ducts Copious secretions Parasympathetic overactivity; overstimulates respiratory secretions Apnea Penetration of blood  – brain barrier by nerve agents Neurological responses: confusion, Penetration of blood  – brain barrier by nerve agents forgetfulness, insomnia, impaired  judgment, depression, irritability, loss of consciousness, seizures Urinary and fecal incontinence Increase in parasympathetic tone; overstimulates digestive secretions and urinary/fecal activity Weakness Prolonged stimulation of receptors at the neuromuscular junction   Prepared by: John Eric D. Rosales, RN, RM, MAN Lecture Notes for Acute Biologic Crisis Bioterrorism handouts Fasciculations Stimulation of receptors at the neuromuscular  junction Remember the symptoms of nerve agent exposure by using DUMBBELS D iarrhea U rination M iosis B ronchospasm B radycardia E mesis L acrimation S alivation Protect yourself by wearing personal protective equipment (PPE) when caring for these clients. Tests:    RBC ACHE activity: decreases after exposure to nerve agents.    ABGs: assess ventilation.    Cardiac telemetry: detect arrhythmias.    Electroencephalography in unresponsive clients: detects nonconvulsive status epilepticus. Treatments:    Decontamination: use large amount of soap and water or saline solution for 20 minutes on client’s skin: blot off the water, don’t wipe. Bag belongings to use as identification of the chemical agent.    Maintain airway: improves oxygenation and tissue perfusion.    Suction frequently: to rid of copious secretions; plastic airway equipment will absorb sarin gas, resulting in continued exposure to the agent.1    IV atropine 2 to 4 mg followed by 2 mg every 3 to 8 minutes for up to 24 hours of treatment: decreases secretions and tachycardia, and decreases gastrointestinal motility.    Pralidoxime 1 to 2 g in 100 to 150 mL of normal saline solution given over 15 to 30 minutes: allows cholinesterase to become active against acetylcholine.    Diazepam (Valium): controls seizures; decreases fasciculations; alleviates apprehension and agitation.    MARK I kit: includes prepackaged autoinjectors of atropine 2 mg and pralidoxime 600 mg to be given into the thigh muscle by the client. What can harm my client?    Recontamination.   Prepared by: John Eric D. Rosales, RN, RM, MAN Lecture Notes for Acute Biologic Crisis Bioterrorism handouts    Coma.    Respiratory distress.    MI. Vesicants Vesicants include:    Lewisite    Phosgene    nitrogen mustard    sulfur mustard Vesicants are colorless or yellowish/brown chemicals that cause blistering. They are typically persistent oily liquids that can cause symptoms from within seconds (lewisite, phosgene) to 24 to 36 hours (mustard). When absorbed, blister agents cause chemical cellular damage within minutes by inhibiting DNA replication, which causes cellular death. Most affected organs:    Eyes    Skin    Respiratory tract SIGNS AND SYMPTOMS WHY Skin exposure: Similar to that of large superficial Vesicant penetrates thin skin causing damage To partial thickness burn in warm, moist areas of Body (perineum, axillae, antecubital spaces) stinging, Erythema for 24 hours followed by pruritus, painful, Burning, small vesicle formation after 2 to 18 hours, Dermatologic cancers Large, fluid-filled bullae; hives, welts Small vesicles grow deeper and larger due to cell damage Respiratory effects: purulent discharge, cough, Inflammatory response violent sneezing, copious mucus production, obstructed airways, recurrent respiratory infections, lung fibrosis, asthmatic bronchitis, upper airway cancers Eye exposure: pain, photophobia, lacrimation, Vesicant diffuses into aqueous solution causing damage to cells of eye decreased vision, conjunctivitis, blepharospasm, corneal ulcer, corneal edema
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