A couple of 8-year-olds were playing in the attic and decided to go through one of their grandpa's old chests of WWI "treasures
" Digging deep down to the bottom, they found what looked like an old bombshell, which seemed to be leaking around the edges. As they were handling it and looking it over, they got the substance on themselves and on their pants. They heard their mom call them for lunch and quickly went down to eat. Later that day, both developed itching, rashes, and lesions with blisters. They began to get worse and were taken to the ED.
a. What is the first assessment of these two clients upon entering the ED?
b. What is the treatment for blistering agents?
c. Are you and others at risk for contamination? Who needs to be contacted, if any?
d. What other chemical agents are considered possible agents of human disaster?
Students' answers should include the following:
a. Assessment of these two clients shows they are in acute distress. The lesions and blisters are consistent with sulfur mustard, and a thorough history must be taken fast to know what they have handled to appropriately treat the victims before they die.
b. Treatment would be to give the only antidote if available, dimercaprol, or BAL, as soon as possible. Lesion care is similar to burn care. Clients should be put on mechanical ventilation for supportive airway protection. They may also need Neupogen and Epogen for bone marrow suppression or blood marrow transfusion.
c. Yes, everyone is at risk for contamination, unless the clothing and everything that came into contact with the boys and their clothing has been decontaminated and destroyed, including the things in the attic with grandpa's chest.
You will need to contact other disciplinarians to make sure follow through with decontamination process of the home and family as well as the neighborhood has been taken care of. Also, all hospital staff and equipment must be decontaminated.
d. Chemical disasters besides nerve agents poisoning like the muscarinic and nicotinic receptors are cyanide poisoning, chlorine and phosgene or respiratory poisoning, and the blistering agents or vesicants like mustard gas.
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