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Mustards

Mustards (H, HD)
Sulfur Mustard (H), Liquid Mustard (HD)

Diagnosis

1.
Skin: erythema and blisters (may be delayed up to 8 hrs)

2.
Eyes: conjunctivitis, corneal opacity, damage, lacrimation, blepharospasm

3.
Airway: mild to marked airway damage; pneumonitis within 1-3 d

4.
GI effects and bone marrow stem cell suppression

5.
Odor: garlic, horseradish, or mustard

6.
Leukocytosis, fever, sputum production

7.
Thiodiglycol measured by Theater Army Medical Laboratory (TAML)
History

1.
First synthesized in early 1800s

2.
First used during WWI by Germany in July 1917

3.
Italy allegedly used in 1930’s against Abyssinia

4.
Egypt apparently used in 1960’s against Yemen

5.
Iraq used in 1980’s against Iran and Kurds
Pathophysiology

1.
Oily liquid with color from light yellow to brown

2.
Fair skinned more at risk for adverse dermal effects

3.
Dissolves in sweat or ECF; prefers heat, humidity

4.
Mustard can’t be isolated in blister fluid

5.
Persists in soil for wks

6.
Case fatality rate: 2-4%

7.
WBC <200 is harbinger for fatality

8.
Toxic dermal dose: 0.1% soln

9.
Primarily liquid hazard; 100 deg F; freezes 57 deg F

10.
Persistence: liquid: 1-2 d

11.
Sulfur Mustard (H):

Danger to life/health: 0.003 mg/m3

LCt50 vapor:

unprotected 1500 mg/min/m3

resp protection 10,000 mg/min/m3

12.
Liquid mustard (HD):

LD50: skin 100 mg/kg

Ocular injury: 200 mg/min/m3

Dermal absorbtion: 2000 mg/min/m3
Decontamination

1.
0.5% hypochlorite soln

2.
M291 kit

3.
H2O in large amounts (not hot)

4.
If no H2O, use Fuller’s earth

5.
Remove all contaminated clothing

6.
Towels soaked in 0.2% chloramine

7.
Towels soaked in H2O (Dakin soln) placed over wounds for first 2 hrs helpful
Treatment

1.
Skin: calamine, silver sulfadiazine 1% bid

2.
Eye: homatropine ophthalmic ointment

3.
Pulmonary: antibiotics, bronchodilators

4.
Do not fluid resuscitate as in thermal burns

5.
Petroleum jelly placed on eyelid margins may prevent eyelid adherence

6.
Colony stimulating factor helpful in leukopenia

7.
Systemic analgesics

8.
O2, early use of PEEP or CPAP
Disposition

1.
Admit

2.
Notify CDC & local health dept
Military Dectection/Treatment Kits
(See Chemical Agent ID/Detection)

1.
M256A1, M272, MINICAMS, ICAD, M18A2, M21, M90, M93A1 Fox, Bubbler, CAM, DAAMS, M8 paper, or M9 paper

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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