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Review Article| Volume 35, ISSUE 4, P633-645, October 2019

Chemical Agents in Disaster

Care and Management in the Intensive Care Unit

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      References

      1. 1925 Geneva Protocol.
        (Available at:) (Accessed March 2, 2019)
        • Smart J.K.
        History of chemical and biological warfare: an American perspective.
        in: Sidell F.R. Takafuji E.T. Franz D.R. Medical aspects of chemical and biological warfare, in Zajtchuk R, Bellamy RF (editors): Textbook of military medicine, Part I: warfare, Weaponry and the casualty. United States Department of the Army, Office of the Surgeon General and Borden Institute, Washington, DC1997: 9-86
        • Okudera H.
        • Morita H.
        • Iwashita T.
        • et al.
        Unexpected nerve gas exposure in the city of Matsumoto: report of rescue activity in the first sarin gas terrorism.
        Am J Emerg Med. 1997; 15: 527-528
        • Okumura T.
        • Takasu N.
        • Ishimatsu S.
        • et al.
        Report on 640 victims of the Tokyo subway sarin attack.
        Ann Emerg Med. 1996; 28: 129-135
      2. Convention on the prohibition of the development, production, stockpiling and use of chemical weapons and on their destruction (chemical weapons convention).
        (Available at:) (Accessed March 1, 2019)
        • Chalela J.A.
        • Burnett T.
        Chemical terrorism for the intensivist.
        Mil Med. 2012; 177: 495-500
        • Okumura T.
        • Suzuki K.
        • Fukuda A.
        • et al.
        The Tokyo subway sarin attack: disaster management, Part 2: hospital response.
        Acad Emerg Med. 1998; 5: 618-624
        • Urbanetti J.S.
        Toxic inhalational injury in Sidell FR.
        in: Takafuji E.T. Franz D.R. Medical aspects of chemical and biological Warfare,in Zajtchuk R, Bellamy RF (editors): Textbook of military medicine, Part I: warfare, Weaponry and the casualty. United States Department of the Army, Office of the Surgeon General and Borden Institute, Washington, DC1997: 247-270
        • Das R.
        • Blanc P.D.
        Chlorine gas exposure and the lung.
        Toxicol Ind Health. 1993; 9: 439
        • Bunting H.
        The pathology of chlorine gas poisoning.
        in: Fasciculus on chemical warfare medicine. vol. 2. Committee on Treatment of Gas Casualties, National Research Council, Washington, DC1945: 24
      3. Prevention and treatment of injury from chemical warfare agents.
        Med Lett Drugs Ther. 2002; 44: 1-4
        • Van Sickle D.
        • Wenck M.A.
        • Belfiower A.
        • et al.
        Acute health care effects after exposure to chlorine gas released after a train derailment.
        Am J Emerg Med. 2009; 27: 1-7
        • Baker D.J.
        Management of respiratory failure in toxic disasters.
        Resuscitation. 1999; 42: 125-131
        • The Acute Respiratory Distress Syndrome Network
        Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
        N Engl J Med. 2000; 342: 1301-1308
        • Parkhouse D.A.
        • Brown R.F.
        • Jugg B.J.
        • et al.
        Protective ventilation strategies in the management of phosgene-induced acute lung injury.
        Mil Med. 2007; 172: 295-300
        • Li W.
        • Rosenbruch M.
        • Pauluhn J.
        Effect of PEEP on phosgene-induced lung edema: pilot study on dogs using protective ventilation strategies.
        Exp Toxicol Pathol. 2015; 67: 109-116
        • Graham S.
        • Fairhall S.
        • Rutter S.
        • et al.
        Continuous positive airway pressure: an early intervention to prevent phosgene-induced acute lung injury.
        Toxicol Lett. 2018; 293: 120-126
        • Wang J.
        • Winskog C.
        • Edston E.
        • et al.
        Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs.
        Acta Anaesthesiol Scand. 2005; 49: 183-190
        • Grainge C.
        • Rice P.
        Management of phosgene-induced acute lung injury.
        Clin Toxicol. 2010; 48: 497-508
        • Sciuto A.M.
        • Strickland P.T.
        • Kennedy T.P.
        • et al.
        Protective effects of N-acetylcysteine treatment after phosgene exposure in rabbits.
        Am J Respir Crit Care Med. 1995; 151: 768
        • Rendell R.
        • Fairhall R.
        • Graham S.
        • et al.
        Assessment of N-acetylcysteine as a therapy for phosgene-induced acute lung injury.
        Toxicol Lett. 2018; 290: 145-152
        • Sciuto A.M.
        • Hurt H.H.
        Therapeutic treatments of phosgene-induced lung injury.
        Inhal Toxicol. 2004; 16: 565-580
        • Wang L.
        • Wu D.
        • Wang J.
        Chlorine gas inhalation manifesting with severe acute respiratory distress syndrome successfully treated by high-volume hemofiltration: a case report.
        Medicine (Baltimore). 2018; 97: e11708
        • Russell D.
        • Blaine P.G.
        • Rice P.
        Clinical management of casualties exposed to lung damaging agents: a critical review.
        Emerg Med J. 2006; 23: 421-424
        • Leikin J.B.
        • Thomas R.G.
        • Walter F.G.
        • et al.
        A review of nerve agent exposure for the critical care physician.
        Crit Care Med. 2002; 30: 2346-2354
        • Sidell F.R.
        Nerve agents.
        in: Sidell F.R. Takafuji E.T. Franz D.R. Medical aspects of chemicaland biological warfare, in Zajtchuk R, Bellamy RF (editors): Textbook of military medicine, Part I: warfare, Weaponry and the casualty. United States Department of the Army,Office of the Surgeon General and Borden Institute, Washington, DC1997: 129-180
        • Wiener S.W.
        • Hoffman R.S.
        Nerve agents: a comprehensive review.
        J Intensive Care Med. 2004; 19: 22-37
        • Thomas R.G.
        Chemoterrorism, in nerve agents.
        in: Walter F.B. Klein R. Thomas R.G. Advanced Hazmat life support provider manual. 3rd edition. University of Arizona Board of Regents, Tucson (AZ)2003: 302
        • Chuang F.R.
        • Jang S.W.
        • Lin J.L.
        • et al.
        QTc prolongation indicates a poor prognosis in patients with organophosphate poisoning.
        Am J Emerg Med. 1996; 14: 451-453
        • Yanagisawa N.
        • Morita H.
        • Nakajima T.
        Sarin experiences in Japan; acute toxicity and long-term effects.
        J Neurol Sci. 2006; 249: 76-85
        • Liu J.
        • Uchea C.
        • Wright L.
        • et al.
        Chapter 34 – Chemical warfare agents and the nervous system.
        in: Gupta R.C. Handbook of toxicology of chemical warfare agents. 2nd edition. Academic Press, London2015: 463-475
        • Senanayake N.
        • de Silva H.J.
        • Karalliedde L.
        A scale to assess severity in organophosphorous intoxication: POP scale.
        Hum Exp Toxicol. 1993; 12: 297-299
        • Horton D.K.
        • Berkowitz Z.
        • Kaye W.E.
        Secondary contamination of ED personnel from hazardous materials events, 1995-2001.
        Am J Emerg Med. 2003; 21: 199-204
        • Lee E.C.
        Clinical manifestations of sarin nerve gas exposure.
        JAMA. 2003; 290: 659-662
        • de Jong R.H.
        Nerve gas terrorism: a grim challenge to anesthesiologists.
        Anesth Analg. 2003; 96: 819-825
        • Cosar A.
        • Kenar L.
        An anesthesiological approach to nerve agent victims.
        Mil Med. 2006; 171: 7-11
        • Berkenstadt H.
        • Marganitt B.
        • Atsmon J.
        Combined chemical and conventional injuries---pathophysiological, diagnostic and therapeutic aspects.
        Isr J Med Sci. 1991; 27: 623-626
        • Marik P.
        • Bowles S.
        Management of patients exposed to biological and chemical warfare agents.
        J Int Care Med. 2002; 17: 147-161
        • Pawar K.S.
        • Bhoite R.R.
        • Pillay C.P.
        • et al.
        Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial.
        Lancet. 2006; 368: 2136-2141
        • Watson A.
        • Opresko D.
        • Young R.A.
        • et al.
        Chapter 9 – Organophosphate nerve agents.
        in: Gupta R.C. Handbook of toxicology of chemical warfare agents. 2nd edition. Academic Press, London2015: 87-109
        • McDonough Jr., J.H.
        • McMonagle J.
        • Copeland T.
        • et al.
        Comparative evaluation of benzodiazepines for control of soman-induced seizures.
        Arch Toxicol. 1999; 73: 473-478
        • McCarren H.S.
        • Arbutus J.A.
        • Cherish A.
        • et al.
        Dexmedetomidine stops benzodiazepine-refractory nerve agent-induced status epilepticus.
        Epilepsy Res. 2018; 141: 1-12
        • Sidell F.R.
        • Urbanetti J.S.
        • Smith W.J.
        • et al.
        Vesicants.
        in: Sidell F.R. Takafuji E.T. Franz D.R. Medical aspects of chemical and biological warfare, in Zajtchuk R, Bellamy RF (editors): Textbook of military medicine, Part I: warfare, Weaponry and the casualty. United States Department of the Army, Office of the Surgeon General and Borden Institute, Washington, DC1997: 197-228
      4. Medical management guidelines for blister agents: sulfur mustard agent H or HD & sulfur mustard agent HT.
        (Available at:) (Accessed March 1, 2019)
        • McManus J.
        • Huebner K.
        Vesicants.
        Crit Care Clin. 2005; 21: 707-718
        • Safarinejad M.R.
        • Moosavi S.A.
        • Montazeri B.
        Ocular injuries caused by mustard gas: diagnosis, treatment, and medical defense.
        Mil Med. 2001; 166: 67-70
        • Emad A.
        • Rezaian G.R.
        The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure: analysis of 197 cases.
        Chest. 1997; 112: 734-738
        • Thomason J.W.
        • Rice T.W.
        • Milstone A.P.
        Bronchiolitis obliterans in a survivor of a chemical weapons attack.
        JAMA. 2003; 290: 598-599
        • Wattana M.
        • Bey T.
        Mustard gas or sulfur mustard: an old chemical agent as a new terrorist threat.
        Prehosp Disaster Med. 2009; 24: 19-29
        • Karayilanoğlu T.
        • Gunhan O.
        • Kenar L.
        • et al.
        The protective and therapeutic effects of zinc chloride and desferrioxamine on skin exposed to nitrogen mustard.
        Mil Med. 2003; 168: 614-617
        • Freitag L.
        • Firusian N.
        • Stamatis G.
        • et al.
        The role of bronchoscopy in pulmonary complications due to mustard gas inhalation.
        Chest. 1991; 100: 1436-1441
        • Anderson D.R.
        • Holmes W.W.
        • Lee R.B.
        • et al.
        Sulfur mustard-induced neutropenia: treatment with granulocyte colony-stimulating factor.
        Mil Med. 2006; 171: 448-453
        • Baskin S.I.
        • Brewer T.G.
        Cyanide poisoning.
        in: Sidell F.R. Takafuji E.T. Franz D.R. Medical aspects of chemical and biological warfare, in Zajtchuk R, Bellamy RF (editors): Textbook of military medicine, Part I: warfare, Weaponry and the casualty. United States Department of the Army, Office of the Surgeon General and Borden Institute, Washington, DC1997: 271-286
      5. Toxicological profile for cyanide. U.S. Department of health and human Services.Public health Service.Agency for toxic Substances and Disease Registry. 2006 (Available at:) (Accessed February 24, 2019)
        • Fortin J.L.
        • Desmettre T.
        • Manzon C.
        • et al.
        Cyanide poisoning and cardiac disorders; 161 cases.
        J Emerg Med. 2010; 38: 467-476
        • Kales S.N.
        • Christiani D.C.
        Acute chemical emergencies.
        N Engl J Med. 2004; 350: 800-808
        • Brivet F.
        • Delfraissy J.F.
        • Duche M.
        • et al.
        Acute cyanide poisoning: recovery with non-specific supportive therapy.
        Intensive Care Med. 1983; 9: 33-35
        • Bebarta V.S.
        • Brittain M.
        • Matthew C.
        • et al.
        Sodium nitrite and sodium thiosulfate are effective against acute cyanide poisoning when administered by intramuscular injection.
        Ann Emerg Med. 2017; 69: 718-725.e4
        • Thompson J.P.
        • Marrs T.C.
        Hydroxocobalamin in cyanide poisoning.
        Clin Toxicol (Phila). 2012; 50: 875-885
        • Legrand M.
        • Michel T.
        • Daudon M.
        • et al.
        Risk of oxalate nephropathy with the use of cyanide antidote hydroxocobalamin in critically ill burn patients.
        Intensive Care Med. 2016; 42: 1080-1081
        • Mégarbane B.
        Hydroxocobalamin-attributed risk of oxalate nephropathy: evidence is not sufficient to change the recommended management of cyanide toxicity by fire smoke inhalation.
        Intensive Care Med. 2016; 42: 1197-1198