Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Slide 25
Chemical Agents of Opportunity for Terrorism:
TICs & TIMs
Next Gas:
Homemade WWI Warfare Agent
• 29 yr old man with acute respiratory distress after
cleaning toilet
• RR 36/min, HR 128/min, BP 148/76
• Lip and throat swelling
• Diffuse wheezing
• Required intubation
and positive pressure
ventilation
• Hypoxia with CXR
Module One – Toxic Industrial Gases as Terrorist Threats
25
The next toxic gas we will discuss has a long history of use as a chemical warfare agent.
This young man developed symptoms while at home cleaning his bathroom. The rapid
onset of mucous membrane irritation, rapid respirations, upper airway and lower airway
injury suggests exposure to an intermediate water-soluble irritant. The low oxygenation
and Chest X-ray abnormalities (shown on next slide) indicate the degree of lung injury.
The patient presents with a number of abnormalities as a result of his exposure to
chlorine. These include a rapid respiratory rate (RR). Normal respiratory rate is 16-20.
This patient has a much faster respiratory rate suggesting some type of respiratory
distress. In addition the HR (heart rate) is also increased to 128 (normal 60-100). This
occurs from the stress – physiologic and psychologic (pain, hypoxia, sympathomimetic
response) - that develops after a significant toxic gas inhalation.
Given the irritating effects of the chlorine, tissues that are in contact with the chlorine
such as the lips and throat will become edematous (swell up) as a part of the
inflammatory response. In a more significant exposure the lungs can be affected and
the patient can develop wheezing which may resemble asthma.
Patients with significant lung involvement may develop hypoxia. Hypoxia refers to a
condition of inadequate oxygenation – in this case due to lung injury and the inability to
transfer oxygen from the lungs to the blood. Patients that develop hypoxia require
supplemental oxygen. For those who develop significant hypoxia (and airway edema),
intubating the patient with an endotracheal tube and placing them on a ventilator that
delivers positive pressure ventilation may be required.
December 2008 Version 2.0 Page 149