ABSTRACT
Emergency situations caused by chemical weapons of mass destruction add a new dimension of risk to those handling and treating casualties. The fundamental difference between a hazardous materials incident and conventional emergencies is the potential for risk from contamination to health care professionals, patients, equipment and facilities of the Emergency Department. Accurate and specific guidance is needed to describe the procedures to be followed by emergency medical personnel to safely care for a patient, as well as to protect equipment and people. This review is designed to familiarize readers with the concepts, terminology and key operational considerations that affect the in-hospital management of incidents by chemical weapons.
Subject(s)
Case Management , Chemical Warfare Agents/adverse effects , Chemical Warfare , Emergency Service, Hospital , Decontamination , Disaster Planning , Emergencies , Health Personnel , Hospitalization , Humans , Inpatients , Occupational Diseases/prevention & control , Panic , Poison Control Centers , Poisoning/diagnosis , Poisoning/etiology , Poisoning/therapy , Protective Clothing , Protective Devices , Risk , Safety , Stress, Psychological/etiology , Stress, Psychological/therapy , Triage , Water Pollution, Chemical , Water Purification/methodsABSTRACT
In last years an increasing number of evidences has been gained that inflammatory response plays a major role in critical illness. The acronym SIRS (Systemic Inflammatory Response Syndrome) has been introduced to define the condition in which the inflammatory reaction exceeds local mechanisms of containment and inflammatory mediators invade the bloodstream causing systemic disturbances. Theoretically, the use of corticosteroids offers a potent tool to control the excess of inflammatory reaction, but initial trials on Adult Respiratory Distress Syndrome (ARDS), head trauma, and septic shock showed not only that mortality was unaffected, but also that morbidity could increase. Recently, however, some new studies have suggested that corticosteroids given at dosages lower than those initially tested, could positively affect late stages of ARDS by preventing pulmonary fibrosis, and septic shock by improving hemodynamics and facilitating the weaning from catecholamines. To date, it is not clear whether these effects are related to the correction of an adrenocortical dysfunction.
