Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Slide 55
Chemical Agents of Opportunity for Terrorism:
TICs & TIMs
Special Considerations
• Consider adding sodium bicarbonate to nebulizer in
chlorine gas exposures
• Intravenous and inhaled calcium gluconate, and
continuous cardiac monitoring are important for
hydrogen fluoride exposure
• Observe patients for late pulmonary effects,
particularly in those with severe early symptoms
Module One – Toxic Industrial Gases as Terrorist Threats
55
There are some situations where specialized treatment may provide some incremental
benefit. As an example, the use of sodium bicarbonate in nebulizer treatments may
provide some treatment for the acid generation following chlorine inhalation.
In other situations, specific treatment is definitely indicated. As examples, multiple
administrations of calcium gluconate may be necessary depending on the dose and
delivery route of a hydrogen fluoride exposure; and continued observation of relatively
asymptomatic patients for delayed-onset pulmonary symptoms is indicated following
phosgene exposure.
The importance of accurate identification of the offending agent and
monitoring/treatment of “special agents” should be emphasized (and pointed out on the
following summary slide). This would also be an opportunity to remind the participants of
the importance of correlating or comparing identification information provided, with the
clinical toxidromes observed. As an example, hydrofluoric acid exposure is often initially
misidentified as hydrochloric acid exposure, but the relative predominance of systemic
effects with the former vs. dermal effects should point out the error.
December 2008 Version 2.0 Page 179