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Inhalationals - Inhalational Agents as Inhalational...

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Thomas Burklow, MD Department of Inhalational Agents as Inhalational Agents as Terrorist Weapons Terrorist Weapons Thomas R. Burklow, MD Thomas R. Burklow, MD LTC, MC LTC, MC Division of Pediatric Cardiology Division of Pediatric Cardiology
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Thomas Burklow, MD Department of Historical notes Historical notes First “chemical agent” 423 B.C., Sparta: Burning mixture of pitch, naphtha, and sulfur sulfur dioxide 1915, Ypres, Belgium: Germans release 150 tons of chlorine 1917, Verdun: Germans use phosgene in artillery shells
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Thomas Burklow, MD Department of Agents Agents Phosgene (CG) Chlorine (CL) Diphosgene (DP) Chloropicrin (PS)
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Thomas Burklow, MD Department of Toxicokinetics Toxicokinetics Absorbed almost exclusively by inhalation Penetrates readily to alveolar Not systemically absorbed
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Thomas Burklow, MD Department of Toxicity: LCt Toxicity: LCt 50 50 Toxicity: Lethal concentration-time product (i.e. dose) to kill 50% of a group Ct 50 : agent concentration (mg/m 3 ) multiplied by time (minutes) The lower the LCt 50 , less of the agent is required, and thus more potent is the agent Does not take into account physiological factors Case example exposure to 50 mg/m 3 for 10 minutes is the equivalent exposure dose of 100 mg/m 3 for 5 minutes
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Thomas Burklow, MD Department of Toxicity Toxicity Phosgene Odor threshold (“new mown hay”), 1.5 mg/ m 3 Irritation threshold, 4 mg/ m 3 3200 mg-min/m 2 Chlorine Odor of “swimming pool water” 6000 mg-min/m 2
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Thomas Burklow, MD Department of Clinical effects Clinical effects Exposure clinical latent period (up to 24 hrs) pulmonary edema Creates defects in the alveolar-capillary barrier, but the exact mechanism is unknown Early symptoms may result from irritation of mucosal membranes (conjunctivitis and irritation of larynx) by phosgene or chlorine.
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Thomas Burklow, MD Department of Most prominent clinical symptom: Most prominent clinical symptom: Dyspnea Dyspnea Initially unaccompanied by objective signs of pulmonary damage Hypoxemia, tachypnea, decreased pulmonary compliance Cyanosis may become clinically evident Profound pulmonary edema (pulmonary sequestration of plasma-derived fluid accumulates up to 1 liter/hr)
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Thomas Burklow, MD Department of
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