The document discusses the chain of chemical survival for responding to chemical emergencies. It covers key topics like hazardous materials, chemical weapons, decontamination procedures, antidote stockpiling, and basic supportive care. Personal protective equipment is necessary for first responders and medical personnel, but can impair response time. Antidotes may help reduce medical resources needed but supportive care has saved more lives; no antidote exists for most chemicals. Effective response requires strengthening all links in the chain, including protection, decontamination, antidotes, and supportive care.
Introduction to toxicology gases and metalsNITISH SHAH
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
Getwell Oncology manufactures and markets Epirubicin Hydrochloride for Injection - Epiruba, and other range of complex generics and drug delivery based formulations at a cost effective price.
Introduction to toxicology gases and metalsNITISH SHAH
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
Getwell Oncology manufactures and markets Epirubicin Hydrochloride for Injection - Epiruba, and other range of complex generics and drug delivery based formulations at a cost effective price.
presented by: Miss Prajakta D. sawant, Lecturer at Genesis Institute of Pharmacy, radhanagari.
SECOND YEAR DIPLOMA IN PHARMACY. PHARMACOLOGY AND
TOXICOLOGY(0813).
introduction toxicology, general information on some basic toxins used in day to day life and also unknown toxins we are always in contact with but little do we know about them
presented by: Miss Prajakta D. sawant, Lecturer at Genesis Institute of Pharmacy, radhanagari.
SECOND YEAR DIPLOMA IN PHARMACY. PHARMACOLOGY AND
TOXICOLOGY(0813).
introduction toxicology, general information on some basic toxins used in day to day life and also unknown toxins we are always in contact with but little do we know about them
Dentists and dental health care workers may face potential occupational hazards due to exposure risks inherent in the profession . Dental practitioners are at the risk of exposure to blood-borne pathogens like HIV , HBV, HCV. STRESS can never be totally eliminated from dental practise , however it can be managed .
Chemical based hazards in pharmaceuticalHari Haran
To convey the knowledge necessary to understand
issues related to different kinds of hazard and their management. Basic theoretical and practical discussions integrate the proficiency to handle the emergency situation in the pharmaceutical product development process.
SAFETY METHODS IN PHARMACEUTICAL INDUSTRYssuser5a17b2
SAFETY METHODS IN PHARMACEUTICAL INDUSTRY
(a)
(b)
Mechanical, chemical and fire hazards problems.
Inflammable gases and dusts.
Please provide feed back
I Have completed this assignment in 5-6 hours . I am helping others student as well.
Prevention of Accidents in An Operation Theatre Part 2-NURSINGMariaKuriakose5
This contains a detailed information about what causes accidents in an operation theater,its preventive measures and what else to be done to prevent such hazards taking place in an OT
Journal Club - Mortality after Fluid Bolus in African Children with Severe In...Farooq Khan
Critical Appraisal of:
Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;364:2483-95
Research in International Emergency Medicine: Scope, Impact and Challenges
EBM Topic: Subgroup Analysis
Journal Club - Utility of Absolute and Relative Changes in Cardiac Troponin C...Farooq Khan
Critical Appraisal of:
Reichlin et al. Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction.Circulation. 2011;124:136-145
Novel High-sensitivity Troponin Assays
EBM topic: ROC curves
Journal club - Disease progression in hemodynamically stable patients present...Farooq Khan
Critical appraisal of:
Glickman SW et al. Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis. Acad Emerg Med. 2010 17:383-90
Interactive quiz on early goal-directed therapy, surviving sepsis guidelines and EBM topic of prognosis studies.
Journal Club - EMS - "Effect of adrenaline on survival in out-of-hospital car...Farooq Khan
Summary and Critical Appraisal of:
Jacobs et al,"Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial" Resuscitation 82 (2011) 1138– 1143
Introduction to Injury Prevention - An interactive discussion for senior and ...Farooq Khan
Introducing concepts of Injury Prevention to mid-level Emergency Care Providers in the District Hospital setting in rural Sub-Saharan Africa.
An interactive lecture made for the Global Emergency Care Collaborative.
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
Approach to evaluating patients' fitness to drive during an ED encounter.
Review of health advocacy and legal obligations from a Quebec standpoint
Audience: Medical students and residents in a small group environment
Approach to Fever in the Returning TravelerFarooq Khan
Quick diagnostic approach to return travelers presenting to the ED with fever.
Audience: Medical Students and Junior Residents in a small group environment
Approach to fever in the transplant patientFarooq Khan
Quick Approach to solid organ transplant patients presenting to the ED with fever to guide initial work-up and managment.
Audience: Medical students and junior residents in a small group environment
The Impact of Massed versus Spaced Instruction on Learning of Procedural Skil...Farooq Khan
Authors:
F.A. Khan, MDCM, C. Patocka, MDCM, F. Bhanji, MD, MSc, I. Bank, MDCM, FRCPC, FAAP, A. Dubrovsky, MDCM, MSc, FRCPC, D. Brody, MD, FRCPC;
McGill Emergency Medicine Residency Program
Introduction:
Survival from cardiac arrest has been linked to the quality of resuscitation care. Unfortunately, health care providers frequently underperform in these critical scenarios, with a well-documented deterioration in skills following an advanced life support course. Improving initial training and preventing decay in knowledge and skills are a priority in resuscitation education. The purpose of this study was to determine if a resuscitation course taught in a spaced format compared to the usual “massed” instruction results in improved procedural skills.
Methods:
We delivered a case-based pediatric resuscitation course to two cohorts of medical students: one in a spaced format (four 75-minute weekly sessions) and the other in a massed format (a single 5-hour session). Four weeks following course completion, blinded observers assessed each learner at various skills stations. Primary outcomes were performance on bag-valve-mask ventilation (BVMV), intraosseous (IO) insertion, and chest compressions using expert-developed checklists. Secondary outcomes included performance of “key components” of the above skills.
Results:
Forty-five of 48 students completed the study protocol (23 spaced and 22 massed). Students in the spaced cohort scored higher overall for BVMV (6.9 ± 1.4 v. 5.8 ± 1.9, p < 0.04), without significant differences in scores for IO insertion (3.9 ± 1 v. 3.7 ± 1.2, p = 0.575) and chest compressions (10.9 ± 2.7 v. 10.1 ± 2.4, p = 0.342). They were also more likely to administer oxygen during BVMV (OR 47.2, 95% CI 5.2- 423, p < 0.001), adhere to a target ventilation rate (OR 4.9, 95% CI 1.1- 21.2, p < 0.03), use a stool when appropriate for chest compressions (OR 8.3, 95% CI 1.2-59, p < 0.03), and landmark correctly for IO insertion (OR 5.4, 95% CI 1.3-24.3, p < 0.02). The intervention group also had a significantly shorter mean time to IO insertion (30.2 ± 34 seconds v. 62.1 ± 30 seconds, p = 0.002).
Conclusion:
Infrequent yet critically important procedures learned in a spaced format may result in better skill retention and more efficient task completion when compared to traditional massed training.
Global health trends and lessons learned towards better advocacy and develo...Farooq Khan
Written from the perspective of a Canadian Emergency Medicine Resident in July 2013 as a presentation to peers and colleagues for academic purposes only.
Part 1: Advocacy in Emergency Medicine
- Patients, communities and the world at large
Part 2: Global Health trends
- Political, social, economic and environmental determinants
- Emergency Medicine as a global priority
Part 3: Examples of Emergency Medicine development and activism
- Global Emergency Care Collaborative - Uganda
- International Emergency Medicine research at WHO
- Getting involved without leaving the country
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
The chain of chemical survival - handout
1. Adapted from Barelli et al, The comprehensive medical preparedness in chemical emergencies: ‘the chain of chemical survival’, European Journal of
Emergency Medicine 2008, 15:110–118
The Chain of Chemical Survival
HazMats (Hazardous Materials)
Substances that have the potential to harm
people or the environment either byitself or
through interaction with other factors. HazMats
can be gases, liquids, or solids and include
radioactive and chemical materials.
Globally Harmonized System of Classification and
Labelling of Chemicals (GHS) is a UN programme
that addresses classification of chemicals by types
of hazard and proposes harmonized hazard-
communication elements, including labels and
safety data sheets (See table 1).
Health hazard
Substances for which there is
statistically significant evidence based
on at least one study conducted in
accordance with established scientific
principles that acute or chronic health
effects may occur in exposed
individuals. (see Table 2)
Chemical weapons
Difficult to define as any chemical substance can be a weapon if used in an unauthorized or inappropriate way.
Simplified definition: Any weapon that
uses a manufactured chemical with high
killing power, meaning that it requires
small amounts of a chemical agent to kill
large numbers of people.
Chemical Weapons Convention: Defines
them as toxic substances with the
following characteristics:
(1) They have been developed, produced, stockpiled, or used as chemical weapons
(2) They pose a high risk to the objective and purpose of the convention by virtue of their high potential for use in
activities prohibited under the convention
(3) They have little or no use for purposes not prohibited by the convention
Examples in Table 4
Farooq Khan MDCM
PGY3 FRCP-EM
McGill University
November 14
th
2011
2. Adapted from Barelli et al, The comprehensive medical preparedness in chemical emergencies: ‘the chain of chemical survival’, European Journal of
Emergency Medicine 2008, 15:110–118
CDC categories
(1) Biotoxins
(2) Blister agents/vesicants
(3) Blood agents
(4) Caustics (acids)
(5) Choking/lung/pulmonary agents
(6) Incapacitating agents
(7) Long-acting anticoagulants
(8) Metals
(9) Nerve agents
(10)Organic solvents
(11)Riot control agents/tear gas
(12)Toxic alcohols
(13)Vomiting agents
4 basic categories of chemical weapons
1. Nerve agents: sarin, tabun, soman, and VX
2. Pulmonary and choking agents: phosgene and chlorine gases
3. Blood or asphyxiant agents: hydrogen cyanide and cyanogen chloride
4. Blister and vesicants: mustard, lewisite, phosgene, and oxime
Toxic syndromes relevant to medical management
Irritant gas, asphyxiant, cholinergic, corrosive, hydrocarbon, and halogenated hydrocarbon
Key points of medical care
Protection of healthcare personnel
Healthcare professionals require personal protective equipment (PPE) when performing essential response functions in
contaminated environments or with contaminated patients:
(1) First responders working in the hot zone;
(2) Emergency medical personnel in field decontamination;
(3) Emergency medical personnel at the hospital.
3. Adapted from Barelli et al, The comprehensive medical preparedness in chemical emergencies: ‘the chain of chemical survival’, European Journal of
Emergency Medicine 2008, 15:110–118
First responders working in the hot zone (fire brigades) have to wear level-A suits.
Emergency medical personnel in field decontamination require level-B protection, unless agent can be identified
and its concentration established as not being life-threatening, in which case most often level-C PPE is sufficient.
A similar situation exists at hospitals that may receive not only field-decontaminated patients but also ‘walk-in’
patients, who may have bypassed field decontamination. Level-C protection (using a full-face mask with
powered or non-powered canister-filtration system) is considered adequate for hospital workers. Non-
identifiable substances and those with potential to re-aerosolize with clothing removal mandate organic
vapour/high-efficiency particulate air filter-cartridge mask
Problems and limitations
PPE takes time to wear and impairs dexterity and mobility: not fully trained emergency-care personnel may fail in
performing life-saving interventions. Impaired communication and vision result in poor speech intelligibility and
reduction in wearer’s visual field. Heat and psychological stress limit duration of use to no more than 20–30 min. The
higher the level of protection, the more difficult is the use.
Antidote Stockpiling
Antidotes, through enhanced elimination or direct counteraction of chemicals, may significantly reduce the medical
resources otherwise needed to treat a patient, shorten the period of therapy, and in some cases be a lifesaving
treatment.
Caveat: Misconception that there is an antidote for most poisons and underestimating role of routine management.
National programme of distribution of antidotes plays a fundamental role
Limited by Demographic, geographical, and economic factors e.g. high cost, short shelf-life.
Antidotes have been classified as those needed within the following lapses of time:
o Immediately (within 30 min)
should be stocked at all hospitals, or in ambulances
o Within 2 h
Can be stocked at a certain main hospitals
o Within 6 h
Can be a central or regional depots (e.g. poison control center) and require transport system to
ensure availability or stock small amounts, sufficient to start treatment with locally, with further
supplies being obtained from a central source as required
4. Adapted from Barelli et al, The comprehensive medical preparedness in chemical emergencies: ‘the chain of chemical survival’, European Journal of
Emergency Medicine 2008, 15:110–118
Controversies: questionable safety and efficacy profiles as, no clinical trials exist. Information programmes should be
arranged by poison-information centres in order to familiarize clinical personnel with the proper use of antidotes
Cyanide
Most antidotes (e.g. nitrite, 4-dimethylaminophenol) can be toxic by interfering with tissue oxygenation themselves (e.g.
methemoglobinemia). Hydroxycobalamin has the most favourable side effect profile but requires very large doses.
Nerve agents
Atropine to counteract ACh effects, oximes reactivate inhibited AChE.
Obidoxime and pralidoxime (2-PAM) are effective against sarin, VX, and GF, but ineffective against soman and
cyclosarin. Therefore it is more appropriate to use HI-6 oximes that are effective against all nerve agents; unfortunately
these are not available in aqueous solutions and need to be stored as powder in a separate chamber of autoinjectors
Hydrazines
Colorless liquid with NH3-like odor found in rocket propellants and fuels, boiler-water treatments, chemical reactants,
medicines, and in cancer research.
Convulsive and lethal effects prevented by Pyridoxine hydrochloride
Patient Decontamination
Must be able to activate a plan to control the access of people to the indoor areas and to avoid secondary
contamination of health-care professionals and facilities
Removal to an outside not-contaminated location
Removal of clothing (with protection of privacy)
Prioritize aerosolized or liquid exposures to eyes, skin or clothing
To ensure rapid progression through the zone and save on hospital personnel, ambulatory patients should self-
decontaminate
Multiple shower lines should be established allowing sequential copious warm-water rinse, a hypoallergenic
liquid soap wash, another warm-water rinse, and then a final rinse after walking past other in-use showers
Showers permanently fixed to the ceiling structure of an open-air parking garage or to the side of a building to
allow immediate activation and minimal disruption of routine activities, but should provide shelter from
weather and adequate lighting
Full passive and assisted decontamination should be available with adjustable water temperature
o Attention to washing and rinsing the patient’s back and the non-absorbent backboard
o Use sponges and disposable towels to avoid abrasion
Basic and Supportive Care
Quality supportive care has saved more poisoned patients than any antidote
Caveats to standard ABCDE approach in chemical exposures
Airway/Breathing
In contaminated areas, ventilation should be performed using isolated BMV attached to either O2 or a filtered
compressor source to avoid pushing further toxin from ambient air into the lungs.
5. Adapted from Barelli et al, The comprehensive medical preparedness in chemical emergencies: ‘the chain of chemical survival’, European Journal of
Emergency Medicine 2008, 15:110–118
Intubation provides the optimal isolation and protection
Avoid if possible neuromuscular blocking agents or titrate small doses, e.g. succinylcholine hydrolyzed slowly in
nerve agent toxicity
Rescue crics have unconfirmed safety in contaminated environments.
LMA seals are inadequate with poor lung compliance
Circulation
Placing an IV is awkward when wearing bulky PPE. Most antidotes can be administered quickly IM (e.g. atropine,
pralidoxime) provided there is sufficient perfusion of the tissues. Absorption can be erratic in shock states.
Chemical agents can affect the circulation adversely through multiple mechanisms:
o Vagal stimulation,
o Fluids and electrolytes lost in exocrine-gland secretions or in chemical burns
o Direct depression of myocardial contractility
o Vasodilatation
Disability
Convulsions can occur as direct toxicity (e.g. in nerve agents) or secondary to hypoxia
Treat with benzodiazepines as 1st
line, consider barbiturate coma and EEG monitoring for status epilepticus, as
neuromuscular blockade masks motor activity but CNS seizures may still be present.
Ensure adequate brain oxygenation.
Summary
The chain of chemical survival includes protection strategies, decontamination, antidote stockpiling and supportive care.
One weak link will cause the entire chain to be weak. There is no sense in developing and reinforcing only one link.
Avoid misconception of “one antidote – one poison”
Do not underestimate basic supportive care