Lesson 22 ADMINISTER FIRST AID TO CHEMICAL AGENT CASUALTIES

1
Combat Life Saver
Lesson 22ADMINISTER FIRST AID TOCHEMICAL AGENT
CASUALTIES
Compiled and edited by, 2LT John C. Miller, PA-C
2
Lesson 22ADMINISTER FIRST AID TOCHEMICAL AGENT
CASUALTIES

• INTRODUCTION
• You have already demonstrated your ability to
  initiate emergency care to a casualty suffering
  from nerve agent poisoning. In this lesson, you
  will learn to determine whether additional
  atropine is needed by the nerve agent casualty
  and, if needed, to administer additional
  injections of atropine. You will also learn to
  provide aid to victims of other chemical agents,
  that is, blister agents, blood agents, and
  choking agents.

3
ADMINISTER FIRST AID TOCHEMICAL AGENT CASUALTIES

• TASK
• Identify signs and symptoms of chemical agent
  poisonings and their treatments.
• CONDITIONS
• Given written items pertaining to the
  identification and treatment of chemical agent
  casualties.
• STANDARD
• Score 70 or more points on the 100-point written
  examination.

4
IDENTIFY SIGNS AND SYMPTOMS OFSEVERE NERVE AGENT
POISONING

• Signs of mild nerve agent poisoning such as a
  runny nose, drooling, tightness in the chest,
  cramps, and nausea.
• Strange and confused behavior.
• Wheezing, coughing, and gurgling sounds while
  breathing,
• Severely pinpointed pupils.
• Red eyes with tears present.
• Vomiting.

5
IDENTIFY SIGNS AND SYMPTOMS OFSEVERE NERVE AGENT
POISONING

• Severe muscular twitching (spasms).
• Loss of bladder and bowel control.
• Convulsion.
• Unconsciousness.
• Respiratory failure (not breathing).

6
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Remember Provide care to casualties only after
  you have masked, put on your own protective
  clothing, and decontaminated your own exposed
  skin (if needed).
• Question
• How long do I wait after administering the three
  Mark I kits and CANA?
• Response
• Five minutes.

7
(No Transcript)
8
(No Transcript)
9
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Squat, insert your gloved hand beneath the
  casualty's hood, and take his carotid pulse using
  two fingers (not your thumb).
• Question
• Why squat instead of kneeling?
• Response
• If you kneel, the chemical agents on the ground
  will reduce your protective clothing's ability to
  protect you.

10
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Question
• The casualty requires additional atropine if his
  pulse is under how many beats per minute?
• Response
• If it is under 90 beats per minute.

11
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Administer Additional Atropine
• Remove an atropine autoinjector from your aid
  bag, tear the clear plastic protective bag, and
  remove the autoinjector.
• Form a fist around the autoinjector with your
  dominant hand.
• Grasp the yellow safety cap with your other hand.
  Pull the yellow safety cap away from the body of
  the autoinjector.

12
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Place the green end of the autoinjector against
  and at a 90 degree angle to the injection site.
  Normally, the injection site is on the outer
  thigh below the hip and above the knee. If the
  casualty is very thin, the upper, outer quadrant
  of his buttocks is used as the injection site.
• Apply firm, even pressure to make the
  autoinjector function.

13
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Question
• How long do you leave the needle in the muscle?
• Response
• At least 10 seconds.
• Remove injector from casualty.
• Question
• What should I do with the used injector?
• Response
• Attach the used autoinjector to the casualty's
  outer clothing (pocket flap) to inform medical
  personnel what medication the casualty received
  and how much he received.

14
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Question
• How long should you wait between injections,
  assuming that his pulse rate is still below 90
  beats per minute?
• Response
• Five minutes.
• Administer Additional CANA
• Administer a second CANA if the casualty is still
  suffering convulsions 5 to 10 minutes after
  administering the first CANA. If the casualty
  still has convulsions 5 to 10 minutes later
  administer a third CANA.

15
TREAT A CASUALTY WITH SEVERE NERVEAGENT POISONING

• Question
• What is the maximum number of CANA autoinjectors
  you should administer to a casualty.
• Response
• Three.

16
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
BLISTER AGENTS

• Blister agents act primarily on the eyes,
  respiratory tract, and skin. The eyes are very
  sensitive and are usually the first to be
  affected by blister agents. Signs and symptoms
  affecting the skin and respiratory track may not
  appear for several hours following exposure.

17
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
BLISTER AGENTS

• Eyes
• Sensitivity to light.
• Gritty feeling in eyes.
• Inflammation of the inner eyelids.
• Swelling and spasms of the eyelids.
• Watery eyes.
• Pain.

18
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
BLISTER AGENTS

• Skin
• Itching.
• Swelling and redness.
• Blisters.
• Pain. (If lewisite or phosgene oxide, pain is
  immediate and intense.)

19
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
BLISTER AGENTS

• Respiratory Tract
• Throat irritation (dry, burning sensation).
• Harsh cough and hoarse voice.
• Phlegm (mucous discharge) or frothy sputum.
• Runny nose and frequent sneezing.

20
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
BLISTER AGENTS

• Other
• Headache.
• Nausea and vomiting.
• Diarrhea.

21
TREAT A CASUALTY EXPOSED TO ABLISTER AGENT

• After the casualty is masked, quickly flush the
  casualty's eye if liquid blister agent is present
  in the eye. If agent is present in both eyes,
  flush both eyes.
• Remove and open the casualty's canteen.
• Have the casualty take a deep breath and hold it.
• Lift the casualty's mask from his chin so his
  eyes are exposed.
• Tilt the casualty's head to one side so the eye
  to be flushed is lower than the other eye.
• Have the casualty open his lower eye.

22
TREAT A CASUALTY EXPOSED TO ABLISTER AGENT

• Pour the water from the canteen gently into the
  lower eye, pouring from the inner edge of the eye
  to the outer edge.
• Continue to flush the eye with water until the
  blister agent has been flushed from the eye.
• If both eyes are contaminated, tilt the
  casualty's head so the other eye is now lower
  than the flushed eye and flush the second eye in
  the same manner.
• Replace the casualty's mask. Have him clear his
  mask resume normal breathing.

23
TREAT A CASUALTY EXPOSED TO ABLISTER AGENT

• Question
• What should you do once you have removed any
  liquid blister agent from the casualty's eyes?
• Response
• Decontaminate the casualty's face and exposed
  skin, then evacuate the casualty as soon as
  practical.
• Question
• Assume blisters have formed on the casualty's
  unprotected forearms. Should you decontaminate
  the blisters?
• Response
• Do not decontaminate or break the blistered
  areas.
• Washing eyes may not result in symptoms going
  away. Do not reflush.

24
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
CHOKING AGENTS

• Choking agents are chemical agents that attack
  the lungs and cause them to fill with fluid.
  Early signs and symptoms will subside rapidly and
  allow the casualty to carry on with his combat
  mission if needed. If the casualty was exposed to
  a sufficient amount of choking agent, late signs
  and symptoms usually appear 4 to 24 hours after
  initial exposure.

25
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
CHOKING AGENTS

• Early Signs and Symptoms of Exposure to Choking
  Agents
• Tears.
• Dry throat.
• Tightness in the chest.
• Choking cough.
• Nausea or vomiting.
• Headache.

26
IDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO
CHOKING AGENTS

• Late Signs and Symptoms of Exposure to Choking
  Agents
• Anxiety.
• Wheezing.
• Rapid, shallow breathing.
• Weak, but rapid, pulse (tachycardia).
• Serious attacks of coughing that produce white or
  yellowish fluid, sometimes frothy and tinted with
  blood.
• Cyanosis (bluish tint to lips and nailbeds).
• Shock.
• Respiratory arrest.

27
TREAT A CASUALTY EXPOSED TO CHOKING AGENTS

• Mask the casualty.
• Instruct a casualty with early signs and symptoms
  of choking agent poisoning to sit until the signs
  and symptoms have subsided if the military
  situation permits. Have the casualty evaluated by
  medical personnel when possible.
• If a casualty shows late signs and symptoms, have
  him rest in a sitting position and keep him warm.
  Evacuate him as soon as possible.

28
IDENTIFY SIGNS AND SYMPTOMS OFBLOOD AGENT
POISONING

• Blood agents interfere with the body's ability to
  use oxygen. They may also attack the lungs like
  choking agents. Signs and symptoms of choking
  agent poisoning include
• Dizziness and headache.
• Cherry-red skin.
• Irritation of the eyes, nose, and throat.
• Nausea and vomiting.
• Slow pulse (bradycardia).

29
IDENTIFY SIGNS AND SYMPTOMS OFBLOOD AGENT
POISONING

• Fast and deep breathing in the initial phase,
  followed by shallow breathing and faintness due
  to a decrease of usable oxygen.
• Convulsions.
• Respiratory arrest.
• Cardiac arrest.

30
TREAT A CASUALTY WITH BLOOD AGENT POISONING

• Mask the casualty.
• Evacuate the casualty to the nearest medical
  treatment facility as quickly as possible.

31
ADMINISTER FIRST AID TOCHEMICAL AGENT CASUALTIES

• CLOSING
• Chemical agents are deadly. Immediate treatment
  can help chemical agent casualties to survive
  until they can be evacuated to a medical
  treatment facility where they can receive medical
  treatment. Remember to take adequate protective
  measures yourself before helping a casualty who
  has been overcome by chemical agents.
• This lesson is tested in the written
  multiple-choice examination.

32
Questions