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2.1
Exposure to Nerve Gas
Exposed to Nerve Agents

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 research is being presented at the American Heart Association's High Blood Pressure Research 2010 Scientific Sessions, being held in Washington, D.C., Oct. 13-16, 2010. Story Source: Materials provided by American Heart Association. [sciencedaily.com]

How would the survivors present after a nerve gas attack and what do you need to know to treat them? Dr. [reachmd.com]

(contrast with Bradycardia in adults) Apnea Seizure Adults - common presentations Cholinergic Muscarinic affects are prominent Excessive Salivation and Lacrimation Urination and Defecation Cholinergic Nicotinic affects are also present Muscle fasciculations [fpnotebook.com]

Respiratoric

  • Cough

    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]

    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]

    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]

    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]

    Digestion: nausea, vomiting, abdominal pain, increased urination. Cardiovascular: abnormal blood pressure and heart rate, weakness. [thisisinsider.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]

  • 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]

    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 Anorexia; nausea [emro.who.int]

    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]

    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]

    These symptoms are soon followed by nausea, vomiting, difficulty in breathing, impairment of various cognitive functions and loss of control over bodily functions. [neurophilosophy.wordpress.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]

    Symptoms of mild to moderate exposure include: (from the CDC) Runny nose Watery eyes Small, pinpoint pupils Eye pain Blurred vision Drooling and excessive sweating Cough Chest tightness Rapid breathing Diarrhea Increased urination Confusion Drowsiness [edition.cnn.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]

  • Abdominal Pain

    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]

    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 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]

    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]

    Eyes will swell, tear and possibly go blind a few hours after exposure, and when inhaled or ingested, victims will experience sneezing, hoarseness, coughing up blood, abdominal pain and vomiting. But exposure to mustard gas is not always fatal. [nationalinterest.org]

  • 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]

Jaw & Teeth

  • Foaming at the Mouth

    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]

    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]

    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]

    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]

  • Hypersalivation

    Atropine sulfate blocks the muscarinic effects of acetylcholine that cause bronchorrhoea, hypersalivation, bronchoconstriction and bradycardia, thereby reducing these effects. [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]

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

    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]

    The first symptoms of sarin poisoning include a runny nose, blurred vision, sweating, and muscle twitches. [encyclopedia.com]

    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]

    Immediate signs of sarin exposure include runny nose, watery eyes, constricted (or pinpoint) pupils, blurred vision, excessive sweating, chest tightness, rapid breathing and altered heart rate. [abcnews.go.com]

    However, if you have symptoms like blurred vision, chest tightness and nausea, you may have been affected by a low to moderate dose of VX. [straitstimes.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 abnormalityw/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]

    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 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]

    The first symptoms of sarin poisoning include a runny nose, blurred vision, sweating, and muscle twitches. [encyclopedia.com]

  • 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]

    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]

    Diazapam can also be used to prevent seizures and convulsions. [encyclopedia.com]

  • Irritability

    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]

    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]

    It belongs to the group of blister agents (or vesicants) that work by targeting the eyes, respiratory tract and skin, first as an irritant and then as poison for the body’s cells. It’s particularly grisly and slow acting. [nationalinterest.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]

  • 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]

  • Ataxia

    See hereditary spinal ataxia; epicanthus inversus; jaw-winking phenomenon; tuck procedure; pseudoptosis; Cogan's lid twitch sign; orthopaedic spectacles; Horner's syndrome. acquired aponeurotic ptosis Ptosis caused by a partial disinsertion, dehiscence [medical-dictionary.thefreedictionary.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]

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]

Prophylactic treatment with pyridostigmine bromide may allow for a longer treatment window after exposure to nerve agents, 2 and may improve survival rates. 1 References Geoghegan J, Tong JL. Chemical warfare agents. [centerforhealthsecurity.org]

Medical Treatment Atropine sulfate : The immediate treatment for nerve agent intoxication is intravenous injection of 2 mg atropine sulfate (pediatric dose calculate based on 0.02 mg/kg with a minimum dose of 0.1 mg) (intramuscular injection should be [besurvival.com]

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

Diazapam can also be used to prevent seizures and convulsions. [encyclopedia.com]

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]

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]

This chemical is responsible for telling muscles to contract – when its breakdown is prevented, it prevents muscles from relaxing, which can in turn lead to a range of other effects. Symptoms of exposure to nerve gases are initially mundane. [compoundchem.com]

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