EM Vivas · Radiation and chemical exposure
CBRN ED receiving — decon, atropine and ARS viva
Clinical viva on decontamination, nerve-agent antidotes, mustard, cyanide, and lymphocyte biodosimetry.
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Decon first. PPE, zones, clothing removal then soap-and-water shower; no dirty entry to resus.[2]
Nerve agent. Atropine 2 mg IV repeat to dry secretions; pralidoxime 30 mg/kg early because aging (minutes for soman) prevents reactivation; airway and benzos for seizures.[2][3]
Mustard. No antidote — decon + supportive burns/airway/eye care after latent blistering.[4]
Cyanide. Hydroxocobalamin 5 g IV for rapid collapse/high lactate scenarios as indicated.[5]
ARS. Early emesis and serial lymphocyte fall estimate dose; supportive marrow care; decontaminated patient is low staff radiation risk.[1]
References5ShowHide
- [1]Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med, 2004.PMID 15197022
- [2]Hulse EJ, Haslam JD, Emmett SR, Woolley T. Organophosphorus nerve agent poisoning: managing the poisoned patient. Br J Anaesth, 2019.PMID 31248646
- [3]Worek F, Thiermann H, Wille T. Organophosphorus compounds and oximes: a critical review. Arch Toxicol, 2020.PMID 32506210
- [4]Kehe K, Balszuweit F, Steinritz D, Thiermann H. Molecular toxicology of sulfur mustard-induced cutaneous inflammation and blistering. Toxicology, 2009.PMID 19651324
- [5]Borron SW, Baud FJ, Mégarbane B, et al. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg Med, 2007.PMID 17543660