approach to chemical weapons

What are chemical weapons ?
Chemical weapons are man made weapons that use the
toxic properties of chemical substances to kill, injure or
incapacitate the enemy. They are considered to be
massive destruction weapons by the UN.
Don’t confuse with bacteriological weapons(toxins):
bacteria, viruses, protozoa, parasites or fungi. 16:55Khalid Al-ajouz2

Introduction
Chemical weapons release toxic gases or liquids that attack the
body’s nerves, blood, skin or lungs.
They may produce surface effects such as tears, blistering, or
vomiting, or cause hallucinations or loss of nervous control.
Chemical attacks can contaminate an area for between several
hours and several days or more, compromising equipment and
forcing responders to wear highly restrictive protective clothing
(reducing their efficiency) and take chemical antidotes whose
side effects remain largely unknown.
16:55Khalid Al-ajouz3

International Treaties Against Chemical
Weapons [Extra]
But chemical weapons are illegal and have been banned globally
since the Geneva Convention.
• 1925: Geneva Protocol banned the use of chemical and
bacteriological weapons.
• 1993: Chemical Weapons Convention banned the development,
production, storage, trade and use of chemical weapons.
• Organization for the Prohibition of Chemical Weapons(OPCW).
• Since the creation of the OPCW, more than 80% of the declared
chemical weapons have been destroyed.

Importance of this subject
It’s Not merely found in world war in the past
It is a current threat in neighboring Arab countries in the present !

Despite chemical weapons being banned, it hasn’t prevented
some world leaders from using these brutal weapons against
people.
• In August 2013, Sarin gas has been used in Syria. In one of the
attacks, more than 1400 people died.
• On April 8, 2018 -- an attack in Syria shocked the world. Footage
after the incident showed men, women and children desperately
gasping for air and being hosed down with water by first
responders -- a scene that is often associated with chemical
weapons attacks.

Click here forreferences

Click here for references And here 16:55Khalid Al-ajouz9

Click here

Types of agents
Choking Agents
Blistering agents
Nerve agents
Blood Agents

Volatility & Persistence
One way to classify chemical
warfare agents is according to
their persistency, a measure of the
length of time that a chemical
agent remains effective after
dissemination.
One liter of VX could theoretically
kill one million people and it
persistence makes it deadly for up
to three weeks.
extra

The name chlorine is derived from chloroschloros, meaning green,
referring to the color of the gas.
Chlorine gas can be recognized by its pungent, irritating odor, which is like the
odor of bleach((‫سسسسسسس‬ ‫.سسسس‬ The strong smell may provide warning to people
that are exposed.
 Chlorine is used in industry (manufacture of many products, in paper production,
antiseptic, dyestuffs, food, insecticides, paints, plastics, medicines and in
household cleaning products. Chlorine was also the first gas to be used as a weapon
during World War I.
 It is also used in disinfection of drinking water in very small concentrations that can’t
harm our bodies , but sufficient enough to kill microbes , also it is used in swimming
pools .

The density of chlorine gas is approximately 2.5 times
greater than air, which will cause it to initially remain
near the ground.
People who use laundry bleach and swimming pool
chemicals containing chlorine products are usually
not exposed to chlorine itself. Chlorine is generally
found only in industrial settings.
Chlorine enters the body breathed in with
contaminated air or when consumed with
contaminated food or water.

HEALTH EFFECTS OF CHLORINE
It depend on how the amount of chlorine,the length and
frequency of exposure.
Breathing small amounts of chlorine for short periods of time
adversely affects the human respiratory system. Effects differ
from coughing and chest pain, to water retention in the lungs.
Chlorine also irritates the skin and the eyes.
People’s risk for exposure depends on how close they are to
the place where the chlorine was released, and how chlorine
enter their bodies [ i.e. through skin or eye contact when
released into air , breathing it , drinking or eating it with
contaminated water or foods.

IMMEDIATE SYMPTOMS OF
CHLORINE EXPOSURE
The health effects resulting from most chlorine exposures
begin within seconds to minutes. The severity will vary
according to amount, route and duration of exposure.
Inhalation [ most common ] :
Low level exposures to chlorine in air will cause :
- eye/skin/airway irritation
- sore throat
- cough
prolongedexposure cause olfactory fatigue , and mask the
warning odor of the gas

Ingestion: ingestion of chlorine dissolved in water (e.g.,
sodium hypochlorite or household bleach) will cause
corrosive tissue damage of the gastrointestinal tract.
 Eye/Dermal Contact at high level of exposure :
- chemical burns or ulcerations
- cause frostbite of the skin and eyes
Other symptoms : Nausea and vomiting , blurred vision , watery eyes .

How to react
1. Leave the area where the chlorine was released
and get to fresh air :
- If the chlorine release was outdoors, move away from the area
where the chlorine was released. Go to the highest ground
possible.
2. Remove your clothing, rapidly wash your entire
body with soap and water.
- Quickly take off clothing that has liquid chlorine, don’t pull over
the head ! Cut it off instead .
- Seal the clothing in double plastic bags.
-Do not handle the bags , instead get rid of them or inform the
authority.
3. If your eyes are burning or your vision is blurred, rinse
your eyes with plain water for 10 to 15 minutes
- if you wear lenses , get rid of them before rinsing .
- if you wear glasses , wash them with soap and water
4. If you have swallowed (ingested) chlorine, do not
induce vomiting or drink fluids.

Mustard Vesicants /
Blistering Agents
1.Sulfur Mustard : Named for its garlicky mustard odormustard odor
2.Nitrogen Mustard
Back of Iranian Soldier exposed to mustard agent , In Iraq Iran war

It is most likely to be used by terrorists
Easily manufactured and can be dispersed as a vapor
Most stable and persistent
Attacks eyes, mucous membranes, lungs, and blood
forming organs
No effective therapy available

Toxicity
Dermal exposure :
Burns from vapor or liquid exposure.
Inhalation exposure :
Airway damage at ~ 100 mg min/m3
lethal at ~ 1500 mg min/m3
Eye exposure:
Damage at very small doses ( ~ 10mg)
 Serious damage within 2 minutes , so
decontamination should be Efficient and quick

Protective Equipment
Penetrates natural cell membranes and
numerous man-made materials
Ordinary clothing or surgical gear offer no
protection
Respirator, protective overgarments, gloves
and over-boots are required 16:55Khalid Al-ajouz24

Decontamination
Skin:
Physical absorption or chemical inactivation Avoid water
decontamination when possible; Exposure may
spread/worsen
Mucous Membranes and Eyes :
Flush immediately with water or Normal saline
soft-tissue and extremity wounds :
surgical decontamination technique .

Signs and Symptoms
Eyes
Mild conjunctivitis: 1 to 2 week recovery
Severe conjunctivitis: 2 to 5 week recovery
Mild corneal involvement with erosions: 2 to 3 month
recovery
Severe corneal involvement with ischemic necrosis: several
months of recovery
Dermal: latent period for several hours post exposure
Erythema
Blisters
Deep burning , full thickness skin loss

Cont.
Respiratory Tract :After 4-6 hours latent period
- Irritation and congestion of mucous membranes of the
nasal cavity and throat
- Irritation of epithelium of the trachea and large bronchi
- Fragments of necrotic epithelium cause obstruction :
Pulmonary edema, asphyxia due to obstruction
- Infection complications: ( in 48 h)
Bacterial infection

Cont.
Systemic Effects
-Bone marrow
Deplete all elements of the bone marrow
Development of severe leukopenia or aplastic anemia
Systemic Action
- Can cause serious multi-organ injury

Treatment
No specific treatment available
Aim of therapy is to relieve symptoms, prevent infection, and
promote healing
Great majority (97%) of casualties survive
Eyes : Do not use topical anesthetics or bandage the eyes
irrigation
Cycloplegics (e.g. homatropine)
Topical antibiotics
Vaseline to edges of eyelids
Systemic analgesics (e.g. NSAID's)

Cont.
Skin :Relieve intense pruritis with cool compresses or
corticosteroids in solution ,Do not use creams or ointments
Treat like a burn
Carefully unroof larger blisters
Irrigation 3-4X daily
Topical antibiotics, e.g. Silvedene
Systemic antipruritics
Systemic analgesics
Fluids and electrolytes

Cont.
Respiratory Tract
• Upper airway symptoms : steam inhalation, cough suppressants
• Avoid using antibiotics early on
• Intubation if lower resp. symptoms progress
- Attempt before laryngospasm or significant edema develop
- laryngoscopy with suctioning if evidence of pseudomembrane formation
Bone Marrow :
Bone marrow transplant or transfusion, may be life-saving in selected cases
GI:
Atropine (0.6 mg IM or IV for adults)
IV fluids

Long Term
Medical Sequelae
Prolonged psychological manifestations : depression, loss of libido,
anxiety
Visual impairment, scarring of the skin, chronic bronchitis , airway
hypersensivity
Prolonged eye damage 6-10 years post exposure , late onset
blindness
Sulfur mustard
Known carcinogen ,Increased lung and laryngeal cancer incidence

A victim of an apparent
sarin gas attack outside of
Aleppo, Syria on April 19
click Here for reference
from the London Times

human-made, extremely toxic substance and one of the world’s most
dangerous chemical warfare agents.
also referred to as GB, has no color, odor or taste.
similar to a family of common pesticides called organophosphates,
but much more potent.
As the name implies nerve agent’s work by attacking the nervous
system. Exposure to Sarin can cause death in minutes.
Can be liquid (pure form) or gas
Sarin

History
Originally developed in 1938 Nazi Germany as a pesticide
Found to be 500 times more toxic than cyanide
Germany began to use Sarin as a weapon.
Sarin and other nerve agents were used in chemical warfare
during the Iran-Iraq War in the 1980s.

21 August 2013: Sarin was used in an attack in the Ghouta region of
the Rif Dimashq - Governorate of Syria during the Syrian
civil war.

Biological effectsBiological effects
 Normally, acetylcholine is released from the neuronal cleft to
stimulate the muscle, after which it is degraded by
acetylcholinesterase, allowing the muscle to relax .
sarin is a potent inhibitor of acetylcholinesterase
results in the accumulation of excessive concentrations
of acetylcholine in nerve synapses
stopping nerve endings in muscles from switching off

Aging
◦ Once sarin binds to cholinesterase the chemical stability of it's
interaction with the enzyme can become irreversible with time
due to the loss of an alkyl group. When this happens it's binding
becomes irreversible (aging) and the becomes resistant to the effects of
oxime regenerators such as pralidoxime
◦ Aging develops with a half-time of 5 hours with sarin.

Symptoms
Remember “SLUDE” muscarinic & nicotinic symptoms .
Symptoms within seconds to hours of exposure:
Runny nose Chest tightness
Low or high blood
pressure
Watery eyes Rapid breathing
Slow or fast heart
rate
Drooling Cough
Muscle
fasiculations /
twitching
Excessive sweating Increased urination Weakness
Eye pain Diarrhea Drowsiness
Blurred vision Nausea, vomiting Headache
Small or pinpoint
pupils
Abdominal pain Confusion

Cont.
High Concentrations Can Cause:
Loss of consciousness
Seizures
Respiratory failure - leading to death

Routes of exposure: Air, water , food , clothes will release sarin for
30 minutes after exposure lead to exposure of other people.
Diagnostic Workup : RBC and plasma cholinesterase levels may be
checked. [ but not readily available ]
- No other lap test is useful for acute nerve agent poisoning.

How to react + Treatment {as chlorine }
Immediately remove the patient/victim from the
source of exposure.
Decontamination:
◦ Remove & dispense of contaminated clothing As
quickly as possible. By double plastic bags
◦ Wash skin with large amounts of soap and water
◦ Rinse the eyes with plain water for 10 to 15 minutes if they
are burning or if vision is blurred
◦ If sarin has been swallowed, do not induce vomiting or give
fluids to drink !

According to route of exposure
After Ingestion :
- Check ABC : Ensure that the patient/victim has an unobstructed
airway.
- NPO
- Gastric Lavage
After Inhalation :
- ABC
- In cases of moderate to severe exposure, antidotes alone will not
provide effective treatment, and ventilatory support is essential.
- Suction secretions
By Skin : decontamination of hair and clothes , + Antidote if Systimic
physical signs

MEDICAL TREATMENT:
1. ECG
2. Frequent suctioning , ± Endotracheal intubation and assisted
ventilation maybe required .
3. Diazibam ( Valum ) to control convultions
4. Administration of atropine (if not already given) should precede the
administration of benzodiazepines.
5. 6-Patients/victims who have inhalation exposure and who complain
of chest pain, chest tightness, or cough should be observed and
examined periodically to detect respiratory complications
( bronchitis , Pneumonia , polmunary edema and respiratory failure.
6. Antidote : Atropin( every 5-10 min) + pralodoxime , Military
Autoinjector MARK I

Mark 1 Kit
Contain self injector of : (600mg) Atropin and (2ml) Parlidoxime

Side effects of Atropin
[ Anti Muscarinic action ] :
Blurred vision
Dry mouth
Inability to sweat.
Muscle fasciculations
Mydriasis
Paralytic ileus
Pyrexia
Tachycardia

A cyanide is a chemical
compound that contains the
group C N. This group, known≡
as the cyano group, consists of
a carbon atom triple-bonded to
a nitrogen atom .
 For the salts such as sodium
cyanide and potassium
cyanide, these compounds are
highly toxic.
Hydrocyanic acid HCN is highly
volatile Liquid

Cyanide is hazardous by:

In nature
Cyanides are produced by certain bacteria, fungi and are found in a
number of plants in substantial amounts : as Almonds , wild cherries
and Cassava

Mechanism of toxicity
It produce cellular hypoxia
 by binding to ferric iron
specially that present in
cytochrom oxidase system .
When it bind to this enzyme
complex electron transport is
inhibited
( ATP will not produced ) this is
result in decrease cellular
utilization of oxygen ( hypoxia ) .

Clinical manifestations
Metabolic acidosis
CNS: dizziness, nausea, vomiting, drowsiness, tetany,
hallucations
 CV: arrhythmia, hypohypertension ,Tachycardia
Respiratory: dyspnea, initial hyperventilation
followed by hypoventilation and pulmonary edema
**Common final pathway for cyanide intoxication is
cellular hypoxia

Severity of toxicity
Mild :
Nausea
Dizziness
Drowsiness
Moderate :
loss of concentration
convulsions
vomiting
Severe Toxicity :
Deep coma
Dilated non-reactive pupils
Deteriorating cardio-respiratory function

diagnosis
History .
Clinical presentation : as metabolic acidosis , and bitter almond odor
Lab :
blood cyanide levels can be drawn .
high anion gap metabolic acidosis

Treatment Options
Sodium nitrite 1st
step :
- converts a portion of the hemoglobin into methemoglobin.
- effectively pulling the cyanide off the cells and onto the methemoglobin.
Sodium thiosulfate 2nd
step = bind with Cyano-methHb from previous step
and release Hb , then thiocyanate will be exerted in the kidney
___
Activated charcoal : after ingestion in Asymptomatic patients
Supplemental oxygen : 100%
Amyl nitrite: second line agent used when sodium nitrite is not
available ( same mechanism )
Hydroxocobalamin: direct binding agent, chelate the cyanide.

It provokes serious burns.
breathing it provokes :
abdominal burning heat,
vomits, sweating and muscular
cramps.
Some days after the exposition:
more hemorrhages, icterus, it
affects the heart (arrhythmia)
and it usually provokes death.
Where has it been used?
Gaza (Palestine) in 2009Gaza (Palestine) in 2009
Iraq-iran warIraq-iran war

approach to chemical weapons

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