You are called in to help out in the ED where three UPS workers have just arrived by ambulance that was involved in a package being dropped, discharging a white powder into the air
Two of the workers inhaled the powder and got it on their skin and uniforms. Victim 1, who was catching the box tossed when it dropped, is in respiratory distress, coughing, and wheezing. He states he may also have swallowed some of the substance. Victim 2 has a rash with blisters on his face, hands, and arms. He also inhaled some of the white substance when the box broke open. Victim 3 was a little farther away unloading the van and only inhaled the substance.
a. You are to triage these three clients and decide who the physician sees first. What levels would you triage these victims?
b. What is your assessment of victim 1, victim 2, and victim 3?
c. What treatment do you suggest for victim 1?
d. What treatment for victim 2?
e. What treatment would you decide for victim 3?
f. What are the three pathogens that can be used by terrorists as biological weapons that are also pathogens that can cause humans disasters?
Students' answers should include the following:
a. You would triage these victims immediately. Victim 1 would be considered red or immediate due to his respiratory distress and swallowing the white powder.
Victim 2 has blisters received by direct skin contact of the white powder and is the least serious of the three and would be considered (delayed) yellow or (minimal) green.
Victim 3 would be (delayed) yellow.
b. Assessing the three victims, you would start with a head-to-toe assessment. You would consider ordering labs to confirm what blood, stool, and wound exudates, which victim 2 may have with the skin lesions.
Lab work comes back positive for the anthrax bacterium.
Oxygen may need to be applied for respiratory distress.
c. Victim 1 has inhaled, and possibly swallowed, the white substance, so a 4-week dose of Cipro and Levaquin should be administered.
You will want to closely monitor for further signs of respiratory and possible intubation if his airway becomes inflamed or swollen.
d. Victim 2 has a skin rash from direct contact of the substance, which is the least deadliest form of contact.
The lesions are usually painless and can be treated with an antibiotic such as Cipro or Levaquin. This will also work for his respiratory exposure, too.
e. Treatment for victim 3 will be the same as victim 1; 4 weeks of Cipro or Levaquin because he inhaled the substance.
f. Anthrax, botulism, and smallpox are the three biologic pathogens that can be used as biologic weapons.
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