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Xenobiotic: Vesicant, WMD Blister Agent, Lewisite, Phosgene, Sulfur mustard, Nitrogen mustard

Expected states of matter: Liquid, Vapor, Gas

Purpose: Vesicants typically begin having chemical effects on the body within minutes through a complex mechanism of action but signs and symptoms do not present for 4-6 hours depending on exposure concentrations & time. Treatment begins with early recognition and limiting exposure. Otherwise, treatment is dependant on route of exposure and should be addressed symptomatically.

Signs & Symptoms: Conjunctivitis, Corneal opacification or ulceration. Erythema to the skin, Vesicles. Laryngeal edema, dyspnea or respiratory obstruction. Coagulation necrosis of the skin. Warmth and humidity increase dermal damage, Targets groin and axilla

General Response: Establish zones of control to protect responders & the public Protect responders with appropriate PPE Entry: Level A Decon: Level C Transport: Street level PPE Decon victims with high volume of water Specialized dedon: Soap & water Does victim present risk of secondary contamination? No

Specific Treatments:

● There is no specific antidote available for blister agents. Treatment should be symptomatic and similar to thermal burns.

Albuterol 2.5mg/3mL nebulized over 5-10 minutes For bronchoconstriction

Diphenhydramine 50mg IM/IV over 1-2 min Relieves itching due to dermal damage

Treat pain according to PAIN MANAGEMENT PROTOCOL

Alkaline Gargle 5mL normal saline with 5mL of sodium bicarbonate. Treats pharyngitis Gargle for 10-15 seconds without swallowing 45

● For vapor/gas exposure or liquid exposure to the eyes -

Tetracaine Hydrochloride 1-2 gtts/eye. Analgesic

Rationale for Treatment: Exposure to blister agents are rarely fatal, but designed to incapacitate. They require long periods of convalescence with some of the major threats being infection through multiple routes. Most appropriate definitive care facility would be a burn center.

Source: https://www.osha.gov/SLTC/emergencypreparedness/cbrnmatrix/blister.html http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148621/