Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 55 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Selected Toxidromes and Potential Chemical Etiologies Category Severe gastroenteritis Cholinergic crisis Cellular hypoxia Peripheral neuropathy Mouth pain / ulcerations MMWR 10/3/03 Clinical Syndrome Abdominal pain, emesis profuse diarrhea, shock SLUDGE symptoms, Fasciculations, weakness N/V, headache, AMS, shock, seizures, dec pH Muscle weakness, sensory loss Lip / mouth / pharyngeal ulcerations; burning pain Potential Chemical Etiology Arsenic, Ricin, Colchicine OP insecticides, nicotine CN, SMFA, CO, Azide Hg, As, Thallium, Lead, Paraquat / diquat; caustics, Hg Module One – Toxic Warfare: Looking Beyond Conventional Chemical Weapons 55 Some chemicals cause a characteristic clinical syndrome. These syndromes (or toxidromes) have symptoms/signs that are typical for that particular type of chemical exposure. Some of these toxidromes include severe gastroenteritis, cholinergic crisis, cellular hypoxia, neuropathy and mouth ulcerations. As you can see, a number of chemicals can cause each toxidrome with the syndrome depicted on the slide. It is also important to realize that these are the textbook descriptions and not all patients follow the textbook script to the letter. These descriptions serve as guides and are not definitive confirmation of a cause, particularly given the use of unusual agents. December 2008 Version 2.0 Page 60
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 56 Chemical Agents of Opportunity for Terrorism: TICs & TIMs A Case 49 yo man suddenly develops leg pain while walking • Day 1 - fever, nausea, vomiting • Day 2 - tachycardia, lymph node swelling and shock • Day 3 - kidney failure, vomited blood, heart block • Day 4 - death • Presumed Cause of Death – Septic Shock Module One – Toxic Warfare: Looking Beyond Conventional Chemical Weapons 56 Let’s review a famous case of chemical terrorism. This only involved a single individual, and may be better called an assassination; it caused quite a sensation at the time. A 49 yo man in London suddenly develops right thigh pain while walking Day 1 - fever, nausea, vomiting Day 2 – tachycardia (fast heart beat), lymph node swelling and shock Day 3 - kidney failure, vomited blood, heart block (abnormal heart rhythm) Day 4 - death Presumed Cause of Death – Septic Shock (low blood pressure due to overwhelming infection) December 2008 Version 2.0 Page 61
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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