Presentation
Various different surgical techniques are also presented, together with results and complications. [ncbi.nlm.nih.gov]
Occasionally an abnormal attachment to the superior border of the tarsal plate is present as well. This is the most common form of acquired ptosis. [medical-dictionary.thefreedictionary.com]
The use of nerve agents as a lethal weapon by radical political groups and unstable governments is a clear and present danger. Starting in the 1980’s, the Iraqi military used tabun against Iran. [countervailcorp.com]
How would the survivors present after a nerve gas attack and what do you need to know to treat them? Dr. [reachmd.com]
Congenital ptosis is eyelid drooping that is present at birth; when it develops later, it is referred to as acquired ptosis. Blepharoptosis may be barely noticeable or quite prominent. [medicinenet.com]
Respiratoric
- Cough
In addition, they often cause cough and blood in the sputum (hemoptysis). Retching and shortness of breath also are common. [merckmanuals.com]
Symptoms of acute, high-dose nerve agents include: coughing and breathing problems, loss of consciousness, seizures, paralysis, and coma and potentially death from respiratory/nervous system failure. [publichealth.va.gov]
Initial likely symptoms of coughing, choking, tightness in the chest, nausea, and occasionally vomiting occur minutes after exposure. This may seem quick but it actually means that victims continue to inhale it until symptoms become apparent. [nationalinterest.org]
Fasciculations at site of exposure to liquid Following systemic absorption Tightness in chest, with prolonged wheezing expiration suggestive of bronchoconstriction or increased secretion; dyspnoea, slight pain in chest; increased bronchial secretion; cough [emro.who.int]
Symptoms may include a runny nose, eye pain, drooling, excessive sweating, rapid breathing, coughing, increased urination and nausea, according to the CDC. [time.com]
- Rhinorrhea
/secretions) Sweating Bradycardia (slow heartbeat) Tachycardia (fast heartbeat) Loss of consciousness Convulsions Flaccid paralysis Loss of bladder and bowel control Apnea (breathing stopped) The onset of rhinorrhea and difficulty breathing is usually [besurvival.com]
Exposure Onset: Seconds to minutes following exposure Symptoms : Miosis, rhinorrhea, dyspnea Onset: Up to 18 hours after exposure Symptoms: Sweating, twitching at site of exposure; possibly nausea, vomiting, diarrhea Large Exposure Onset: Seconds to [centerforhealthsecurity.org]
Grading: Severity of exposure (used to dose antidote) Vapor Exposure (Effect in seconds, Peaks in minutes) Low Exposure Miosis Rhinorrhea Dyspnea High Exposure Altered Level of Consciousness Seizure s Apnea Flaccid Paralysis Death Liquid Exposure Small [fpnotebook.com]
This same action also occurs at the gland and organ levels, resulting in uncontrolled drooling, tearing of the eyes (lacrimation) and excess production of mucus from the nose (rhinorrhea). [en.wikipedia.org]
- Dyspnea
Exposure Onset: Seconds to minutes following exposure Symptoms : Miosis, rhinorrhea, dyspnea Onset: Up to 18 hours after exposure Symptoms: Sweating, twitching at site of exposure; possibly nausea, vomiting, diarrhea Large Exposure Onset: Seconds to [centerforhealthsecurity.org]
Symptoms & Effects Depending on the degree of intoxication, symptoms may include: Nervousness and/or restlessness Miosis (contraction of the pupil) Rhinorrhea (runny nose) Excessive salivation Dyspnea (difficulty in breathing due to bronchoconstriction [besurvival.com]
Grading: Severity of exposure (used to dose antidote) Vapor Exposure (Effect in seconds, Peaks in minutes) Low Exposure Miosis Rhinorrhea Dyspnea High Exposure Altered Level of Consciousness Seizure s Apnea Flaccid Paralysis Death Liquid Exposure Small [fpnotebook.com]
Gastrointestinal
- Vomiting
Signs that the nerve gas gets into the brain include; anxiety, confusion, dizziness, nausea, vomiting, seizures and respiratory depression. Death is usually the result of respiratory failure. This occurs by 2 routes. [sites.duke.edu]
Digestion: nausea, vomiting, abdominal pain, increased urination. Cardiovascular: abnormal blood pressure and heart rate, weakness. [thisisinsider.com]
If these nerve agents have been swallowed, do not induce vomiting or give fluids to drink. Seek medical attention immediately. [emro.who.int]
If ingested, do not induce vomiting or flush with fluids. Medical care should be sought immediately. Antidotes are available in many hospitals. Timeline: 1938 - Sarin is developed in Germany as a pesticide. [edition.cnn.com]
Regardless of the route of exposure, the manifestation of nerve agent exposure includes runny nose, chest tightness, pinpoint pupils, shortness of breath, excessive salivation and sweating, nausea, vomiting, abdominal cramps, involuntary defecation and [youtube.com]
- Nausea
Signs that the nerve gas gets into the brain include; anxiety, confusion, dizziness, nausea, vomiting, seizures and respiratory depression. Death is usually the result of respiratory failure. This occurs by 2 routes. [sites.duke.edu]
Sarin gas: a deadly nerve agent Symptoms of exposure to the agent include nausea and violent headaches, blurred vision, drooling, muscle convulsions, respiratory arrest and loss of consciousness, the CDC says. [dailymail.co.uk]
The victim will next have difficulty breathing, and will experience nausea and drooling. [24.wikia.com]
Regardless of the route of exposure, the manifestation of nerve agent exposure includes runny nose, chest tightness, pinpoint pupils, shortness of breath, excessive salivation and sweating, nausea, vomiting, abdominal cramps, involuntary defecation and [youtube.com]
Longer exposures result in tightness of the chest, headache, cramps, nausea, vomiting, involuntary defecation and urination, convulsions, coma, and respiratory arrest. Atropine acts an antidote for nerve agent, including sarin. [encyclopedia.com]
- Diarrhea
Among reported symptoms are chronic fatigue, diarrhea, migraines, dizziness, memory problems, loss of muscle control and loss of balance. "We have to presume that the illnesses the veterans have are related to that exposure. [ourmidland.com]
“If they’re diagnosed with fibromyalgia or had chronic diarrhea for the past four or five years, it’s considered service-connected. It’s presumptive under the law for Gulf War veterans—even if they can’t diagnose the cause. [newsweek.com]
People exposed to these pesticides may experience excessive salivation, tears and sweat, diarrhea, urination, small (constricted) pupils and pulmonary edema, a condition caused by fluid in the lungs, which can lead to death, Nelson said. [livescience.com]
People experience sudden nausea, diarrhea, vomiting, seizures, muscle spasms, excessive runny nose and most dangerously, difficulty breathing – ultimately the main cause of death, Fraga said. [pbs.org]
Symptoms may start immediately if you have inhaled or been exposed to higher amounts of nerve gas: Runny nose and eyes Small pupils or blurry vision Coughing, chest tightness, wheezing, or shortness of breath Nausea and vomiting Abdominal pain or diarrhea [drugs.com]
- Abdominal Pain
Eyes: blurry vision, eye pain, small/pinpoint pupils. Mouth, nose, and lungs: cough, drooling, runny nose, rapid breathing, chest tightness. Skin: excessive sweating. Digestion: nausea, vomiting, abdominal pain, increased urination. [thisisinsider.com]
Symptoms may start immediately if you have inhaled or been exposed to higher amounts of nerve gas: Runny nose and eyes Small pupils or blurry vision Coughing, chest tightness, wheezing, or shortness of breath Nausea and vomiting Abdominal pain or diarrhea [drugs.com]
Weakness Headache Nausea, vomiting, and/or abdominal pain Slow or fast heart rate Symptoms of severe exposure include: Loss of Consciousness Convulsions Paralysis Respiratory failure possibly leading to death. [edition.cnn.com]
Symptoms of nerve agent poisoning include: Neuromuscular Effects Autonomic Nervous System Effects Central Nervous System Effects Twitching Weakness Paralysis Respiratory failure Reduced Vision Small pupil size Drooling Sweating Diarrhea Nausea Abdominal [faculty.washington.edu]
Blurred vision Drooling and excessive sweating Cough Chest tightness Rapid breathing Diarrhea Nausea, vomiting, and/or abdominal pain Increased urination Confusion Drowsiness Weakness Headache Slow or fast heart rate Low or high blood pressure Even a [emergency.cdc.gov]
- Abdominal Cramps
Regardless of the route of exposure, the manifestation of nerve agent exposure includes runny nose, chest tightness, pinpoint pupils, shortness of breath, excessive salivation and sweating, nausea, vomiting, abdominal cramps, involuntary defecation and [youtube.com]
Symptoms of acute, low-dose nerve agent exposure include: runny nose, chest tightness, "pinpoint" or abnormally constricted pupils, excessive salivation and sweating, abdominal cramps, muscle twitching, visual disturbances, headache, slurred speech, nausea [publichealth.va.gov]
Symptoms include: Dilated pupils Headache Sense of pressure Salivation Runny nose or congestion Nausea Vomiting Tightness in chest Anxiety Mental confusion Nightmares Weakness Tremors or twitches Involuntary defecation or urination Abdominal cramps Diarrhea [thoughtco.com]
[…] absorption Tightness in chest, with prolonged wheezing expiration suggestive of bronchoconstriction or increased secretion; dyspnoea, slight pain in chest; increased bronchial secretion; cough; pulmonary oedema; cyanosis Anorexia; nausea; vomiting; abdominal [emro.who.int]
Cardiovascular
- Chest Pain
pains, and an increase in the production of saliva. [osha.gov]
- Cyanosis
[…] exposure to liquid Following systemic absorption Tightness in chest, with prolonged wheezing expiration suggestive of bronchoconstriction or increased secretion; dyspnoea, slight pain in chest; increased bronchial secretion; cough; pulmonary oedema; cyanosis [emro.who.int]
Jaw & Teeth
- Foaming at the Mouth
HALEY SLAMS RUSSIA OVER SYRIAN CHEMICAL ATTACK, WARNS US MAY TAKE 'OUR OWN ACTION' Videos and witness accounts of victims in respiratory distress and foaming at the mouth seem to indicate that sarin is the culprit. Fox News medical analyst Dr. [foxnews.com]
YouTube/Shajul Islam Other victims were seen foaming at this mouth, another possible symptom of nerve-agent exposure. [nytimes.com]
Images from the rebel-held town of Khan Sheikhun showing victims suffering convulsions, breathing problems and foaming at the mouth have shocked the world. [dailymail.co.uk]
The first sign is typically drooling uncontrollably at the mouth, Flower explained. Then, as some images from yesterday’s attack reveal, victims will often then foam around the mouth. “This is very, very common,” he said. [nypost.com]
But doctors from the Syrian-American Medical Society (SAMS) who are in the area say victims exhibited “constricted (or ‘pinpoint’) pupils, foaming at the mouth, and the loss of consciousness, slow heart rate, slow breathing, vomiting, muscles spasms and [newscientist.com]
- Hypersalivation
Atropine sulfate blocks the muscarinic effects of acetylcholine that cause bronchorrhoea, hypersalivation, bronchoconstriction and bradycardia, thereby reducing these effects. [emro.who.int]
Eyes
- Miosis
Exposure Onset: Seconds to minutes following exposure Symptoms : Miosis, rhinorrhea, dyspnea Onset: Up to 18 hours after exposure Symptoms: Sweating, twitching at site of exposure; possibly nausea, vomiting, diarrhea Large Exposure Onset: Seconds to [centerforhealthsecurity.org]
Miosis is a very characteristic symptom of nerve agent intoxication. Victims will often report difficulty in seeing (blurred & dimmed vision). [besurvival.com]
These include, intense constriction of the pupils (miosis) and severe eye pain, constriction of the bronchioles producing labored breathing, nausea and vomiting, lacrimation (tearing), salivation, sweating, urination, defecation, (basically everything [sites.duke.edu]
Signs: General See Cholinergic Toxicity Children - common presentation (initially misdiagnosed in 80% of cases) Cholinergic Muscarinic affects Miosis Excessive Salivation Cholinergic Nicotinic affects Muscle Weakness and hypotonia Lethargy Tachycardia [fpnotebook.com]
Main clinical signs and symptoms Following local exposure Rhinorrhoea and hyperaemia of nasal mucosa membrane Miosis, (pin‐point pupils), sometimes unequal Hyperaemia of conjunctivitae Excessive sweating at site of exposure Frontal headache, eye pain [emro.who.int]
- Blurred Vision
Sarin gas: a deadly nerve agent Symptoms of exposure to the agent include nausea and violent headaches, blurred vision, drooling, muscle convulsions, respiratory arrest and loss of consciousness, the CDC says. [dailymail.co.uk]
The symptoms preceding this include blurred vision, runny nose, tightness in the chest and constriction of the pupils. The victim will next have difficulty breathing, and will experience nausea and drooling. [24.wikia.com]
The first symptoms of sarin poisoning include a runny nose, blurred vision, sweating, and muscle twitches. [encyclopedia.com]
Symptoms can appear within seconds or even hours and include blurred vision, excess salivation, vomiting, difficulty thinking, muscle twitches, convulsions, paralysis and respiratory failure. [undispatch.com]
Symptoms may include: “pinpoint” pupils and blurred vision; difficulty breathing; muscle twitching; excess saliva and other secretions; impaired judgment, seizures and unconsciousness. [voanews.com]
- Diplopia
• Autoimmune disorder • Ach receptors of NMJ • Most often generalized and systemic • Associated thymoma with positive chest CT finding • Surgical thymectomy results in improvement in 75% of case • Early manifestation involve ophthalmic, with ptosis,diplopia [slideshare.net]
- Pupillary Abnormality
abnormality • Associated with pain • Resolve spontaneously with better LF within 3-6 months • If CNIII palsy+ pupillary abnormalityw/u compressive neoplastic or aneurysmal lesion • Treatment= frontalis suspension 30. [slideshare.net]
- Excessive Tearing
This is why exposure to them causes excessive tears, salivation, sweat, urination, diarrhea, and constricted pupils, all leading to fluid in the lungs and pulmonary edema, which can be fatal. [futurism.com]
Musculoskeletal
- Muscle Twitch
[…] and muscle twitching leading to muscle paralysis. Signs that the nerve gas gets into the brain include; anxiety, confusion, dizziness, nausea, vomiting, seizures and respiratory depression. Death is usually the result of respiratory failure. [sites.duke.edu]
twitching, confusion, seizures, paralysis, coma, respiratory paralysis, and death. [youtube.com]
The first symptoms of sarin poisoning include a runny nose, blurred vision, sweating, and muscle twitches. [encyclopedia.com]
A drop of sarin can cause muscle twitching and sweating, according to the CDC. How can people become exposed to the nerve agent? Sarin can be absorbed into the body by inhaling or ingesting it. Also, it can be absorbed through skin or eye contact. [usatoday.com]
Symptoms of acute, low-dose nerve agent exposure include: runny nose, chest tightness, "pinpoint" or abnormally constricted pupils, excessive salivation and sweating, abdominal cramps, muscle twitching, visual disturbances, headache, slurred speech, nausea [publichealth.va.gov]
- Muscle Weakness
Aetiology Ageing, diabetes, stroke, Horner’s syndrome, muscle weakness or damage, myasthenia gravis, brain tumours or cancer, neuropathy. bleph·a·rop·to·sis (blef'ăr-op-tōsis) Drooping of the upper eyelid. Synonym(s): ptosis (2). [medical-dictionary.thefreedictionary.com]
Signs: Nicotinic Receptors (Skeletal muscle, Ganglia) Skeletal Muscle changes Initial Fasciculations Muscle Twitching Later Weakness Flaccid paralysis Ganglion ic effects Tachycardia Hypertension Cardiovascular Effects Heart Block Ventricular arrhythmia [fpnotebook.com]
Superior rectus muscle weakness may occur in association with congenital ptosis. The levator muscle and the aponeurosis appear fatty and fibrous. [entokey.com]
- Muscle Cramp
Workers poisoned by CPF experience vomiting, muscle cramps and twitching, tremors and weakness. [greenlatinos.org]
The only possible point of reference we may have is experiencing an excruciating muscle cramp, but amplified horrendously to muscles throughout the entire body while being choked to death. [blogs.scientificamerican.com]
Neurologic
- Seizure
It causes seizures and has been used as a chemical warfare agent. [fpnotebook.com]
Signs that the nerve gas gets into the brain include; anxiety, confusion, dizziness, nausea, vomiting, seizures and respiratory depression. Death is usually the result of respiratory failure. This occurs by 2 routes. [sites.duke.edu]
The “off-switch” stops working, leading to “tremors, twitching, seizures, convulsions, frothing at the mouth, secretions, loss of bowel and bladder function, and eye constriction,” Siegel said. [foxnews.com]
In addition to diazepam, lorazepam, midazolam and pentobarbital have been used to treat soman-induced seizures. Seizure control declines markedly if there is any delay in treatment; 40 minutes after exposure, control is minimal. [emro.who.int]
- Confusion
After chronic exposure to low levels of nerve gas, victims suffer from a variety of neurological and mental disorders including; depression, insomnia, loss of memory, mental confusion and cognitive problems. [sites.duke.edu]
Annotation do not confuse with Williams-Campbell syndrome, a congenital cartilage deficiency History note 96 Public Note 96 Record number D018980 Persistent link Allowable qualifiers (subheadings) Browse Medical Subject Headings [medvik.cz]
[…] exposure, the manifestation of nerve agent exposure includes runny nose, chest tightness, pinpoint pupils, shortness of breath, excessive salivation and sweating, nausea, vomiting, abdominal cramps, involuntary defecation and urination, muscle twitching, confusion [youtube.com]
[…] nerve agent exposure include: runny nose, chest tightness, "pinpoint" or abnormally constricted pupils, excessive salivation and sweating, abdominal cramps, muscle twitching, visual disturbances, headache, slurred speech, nausea, hallucinations and confusion [publichealth.va.gov]
Getty Images Moderate exposure Head: confusion, drowsiness, and headache. Eyes: blurry vision, eye pain, small/pinpoint pupils. Mouth, nose, and lungs: cough, drooling, runny nose, rapid breathing, chest tightness. Skin: excessive sweating. [thisisinsider.com]
- Irritability
The irritant gas chloramine is released. Some gases—for instance, nitrogen dioxide—do not dissolve easily. [merckmanuals.com]
People who have been exposed to small levels of sarin usually recover completely, but fatigue, irritability, nervousness and memory problems could last for weeks. [voanews.com]
Example agents Tear Gas (CS) Pepper Spray (OC) Dispersal Liquid, aerosol Mode of Action Absorption through lungs, skin and eyes Effects Tears, coughing, and irritation to eyes, nose, mouth and skin; constricts airway [opcw.org]
Symptoms of blepharoptosis may include: Crossed or misaligned eyes Difficulty closing the eye completely Double vision Drooping eyelid Eye fatigue Irritation Tilting of the head Treatment Blepharoptosis is usually corrected with surgery to tighten the [uclahealth.org]
Fatigue, irritability, nervousness, and memory defects may persist for as long as 6 weeks after recovery from an exposure episode. [youtube.com]
- Flaccid Paralysis
paralysis; miosis, nose and mouth secretions Onset: Within 30 minutes of exposure Symptoms: Loss of consciousness, seizures, apnea, flaccid paralysis Transdermal exposure to nerve agents generally results in a slower onset of systemic symptoms, as the [centerforhealthsecurity.org]
Signs: Nicotinic Receptors (Skeletal muscle, Ganglia) Skeletal Muscle changes Initial Fasciculations Muscle Twitching Later Weakness Flaccid paralysis Ganglion ic effects Tachycardia Hypertension Cardiovascular Effects Heart Block Ventricular arrhythmia [fpnotebook.com]
paralysis Loss of bladder and bowel control Apnea (breathing stopped) The onset of rhinorrhea and difficulty breathing is usually very rapid, occurring within seconds to minutes of exposure to nerve agent vapors, and within half an hour of exposure to [besurvival.com]
- Altered Mental Status
Mental Status Autonomic instability IX. [fpnotebook.com]
Treatment
[…] and Treatment التعرف على حالات التعرض لغاز ااسارين وعلاجها English (pdf) (pdf) العربية Tabun Exposure Recognition and Treatment English (pdf) (pdf) العربية VX Exposure Recognition and Treatment English (pdf) (pdf) العربية [phr.org]
A Guelph-based company is using its low-cost drug manufacturing technology based on tobacco plants to develop an Ebola treatment as well as a nerve gas antidote. [aginnovationontario.ca]
Initial analysis on victims brought to Turkey for treatment suggests they were exposed to sarin. [dailymail.co.uk]
Algorithms for pharmacological treatment of personality dimensions: symptom-specific treatments for cognitive-perceptual, affective, and impulsive behavioral dysregulation. Bulletin of the Menninger Clinic, 62, 195-214. Soloff, P.H. (2000). [kenniscentrum-kjp.nl]
It was stated that the Mark 1 Autoinjector kits (although not approved for pediatric use) should be used as initial treatment for children with severe, life-threatening nerve agent toxicity for whom IV treatment is not possible or available, or for whom [academiccommons.columbia.edu]
Prognosis
This prognosis is based on decades of research on rats and mice, and the fate of veterans of the 1990-1991 Gulf War who were exposed to low-levels of sarin gas and who continue to suffer serious health effects 26 years later. [blogs.scientificamerican.com]
Prognosis Good results are usually achieved by the medical and surgical approaches availabe for managing blepharoptosis. Recurrence over time is not uncommon. [eyewiki.aao.org]
Etiology
History usually provides very good clue for the etiology of the blepharoptosis. [eyewiki.aao.org]
Epidemiology
GAO concluded that epidemiological studies that relied on the computer model would be invalid. A Pentagon spokesman reached Friday would not immediately comment on the findings. [ourmidland.com]
The epidemiological pattern of occurrence such as the mass influx of patients in a short time suggests exposure to sarin, a nerve agent in Syria’s arsenal. [undispatch.com]
Biden: Syrian gov't responsible for "heinous use" of chem. weapons Syrian state news agency: Kerry lying about chemical weapons attack "The reported symptoms of the patients, in addition to the epidemiological pattern of the events -- characterized by [cbsnews.com]
Epidemiology Mortality/Morbidity Mortality associated with ptosis usually results from anesthetic complications from surgery. [emedicine.medscape.com]
Journal of Epidemiology. 9 (5): 337–43. doi:10.2188/jea.9.337. PMID 10616267. ^ Millard CB, Kryger G, Ordentlich A, Greenblatt HM, Harel M, Raves ML, Segall Y, Barak D, Shafferman A, Silman I, Sussman JL (June 1999). [en.wikipedia.org]
Pathophysiology
Identification of the underlying pathophysiologic mechanism is paramount to institute proper treatment. Pathophysiology Ptosis is the result of dysfunctioning of one or both upper eyelid elevator muscles. [emedicine.medscape.com]
Pathophysiology Penetrates skin, eyes, and lungs Toxic effects manifest as Cholinergic Toxicity Organophosphate esters ( Acetylcholinesterase Inhibitor s) Most toxic of chemical agents Similar to Insect icide Organophosphate s (e.g. [fpnotebook.com]
Pathophysiology Levator palpebrae superioris and Mueller muscle Blepharoptosis are the upper eyelid elevator muscles. [eyewiki.aao.org]
Prevention
If you want to: Protect children from learning and memory impairments Protect communities from pesticide poisonings when chlorpyrifos drifts in the air into nearby neighborhoods and schools Prevent contamination of our food Prevent contamination of our [greenlatinos.org]
Diazapam can also be used to prevent seizures and convulsions. [encyclopedia.com]
Nerve agents are highly poisonous chemicals that can interfere with the nervous system's signaling, according to the Centers for Disease Control and Prevention (CDC). [livescience.com]
Existing protective gear is effective — gas masks can also prevent people from inhaling toxic chemicals, for example. [pbs.org]
The combination results in death by suffocation, and sarin can contaminate food or water supplies, according to the US Centers for Disease Control and Prevention (CDC). [dailymail.co.uk]