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Module 4Signs and Symptoms
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Situation Assessment

• Known information regarding the chemical release
• Recognition of the event based on signs and
  symptoms

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Not All Signs and Symptoms May Appear Immediately

• Manifestation based on
• dose,
• duration, and
• route of entry

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Nerve Agent Exposure
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Signs and Symptoms Nerve Agent Vapor Exposure

• Affects organs directly contacted by agent
• Affects other organs as agent is absorbed into
  body systems
• Signs and symptoms appear in seconds to minutes
• Peak effects within 15 to 25 minutes after
  exposure stops

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Signs and SymptomsMild Vapor Exposure

• Pinpoint pupils (w/ or w/o redness, pain)
• Dim or blurred vision
• Runny nose
• Slight chest tightness
• Slight difficulty breathing
• Secretions (tears, nasal fluids, saliva, sweat,
  phlegm)
• Nausea and vomiting

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Signs and SymptomsModerate Vapor Exposure

• Pinpoint pupils (w/ or w/o redness, pain)
• Dim or blurred vision
• Excessively runny nose
• Pronounced chest tightness
• Plentiful secretions
• Moderate to severe breathing difficulty
• Nausea and vomiting
• Diarrhea
• General muscle weakness

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Signs and SymptomsSevere Vapor Exposure

• Same as for moderate exposure, plus
• Loss of consciousness
• Convulsions
• Generalized rippling of muscles under skin
• Flaccid paralysis
• Cessation of breathing
• Involuntary urination or defecation

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Signs and SymptomsLiquid Nerve Agent on Skin

• Effects differ from vapor exposure
• Different signs and symptoms
• Different timing of appearance
• General rule the more severe the exposure, the
  quicker effects appear

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Signs and SymptomsMild Liquid on Skin Exposure

• Sweating at site of exposure
• Rippling of muscles under skin at site of
  exposure
• Effects appear in 10 min to 18 hrs, depending on
  dose

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Signs and SymptomsModerate Liquid/Skin Exposure

• Same as for Mild exposure, plus
• Nausea, vomiting, and diarrhea
• Generalized sweating
• Generalized weakness, tiredness, or ill feeling
• Effects appear in 10 min to 18 hrs, depending on
  dose

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Signs and SymptomsSevere Liquid on Skin Exposure

• Same as for Moderate exposure, plus
• Collapse
• Loss of consciousness
• Convulsions
• Severe respiratory difficulty
• Flaccid paralysis
• Cessation of breathing
• Involuntary urination or defecation
• Effects appear suddenly in 2-30 min

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Differential Diagnosis

• Refers to distinguishing one disease from another
  when they produce similar signs and symptoms

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Diseases Producing Symptoms Similar to Nerve
Agent Exposure

• Epilepsy
• Gastroenteritis
• Exposure to agricultural insecticides
  (organophosphates and carbamates)

• Heat illness
• Emphysema
• Stroke
• Head trauma
• Drug overdose

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VESICANT AGENT EXPOSURE
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Signs and Symptoms by Route of Exposure

• Agent vapor affects eyes, skin, and airways
• Agent liquid on skin or eyes
• Produces more severe effects than vapor
• Does not normally affect airways
• Large exposures via either route can affect
  internal body systems

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Signs and Symptoms of Exposure to Mustard Agent
Vapor

• Agent contacts skin and eyes
• Causes surface damage
• Absorbed into body
• Agent is inhaled into respiratory tract
• Damages mucous membranes
• Absorbed into body

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Signs and Symptoms ofVapor Exposure on Eyes

• Mild exposure
• Tearing, itching, burning, gritty feeling,
  sensitivity to light
• Effects appear in 4-12 hrs
• Moderate exposure
• Same as for Mild exposure, plus reddening,
  swelling of lids, moderate pain
• Effects appear in 3-6 hrs
• Severe exposure
• Same as for Moderate, plus marked swelling of
  lids, possible damage to cornea, severe pain
• Effects appear in 1-2 hrs

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Signs and Symptoms of Vapor Exposure on Skin

• Mild exposure
• Reddening of skin with itching, burning, and
  stinging
• Severe exposure
• Same as for Mild exposure, plus blisters
• Effects appear in 2-24 hrs

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Signs and Symptoms of Vapor Exposure on Airways

• Mild exposure
• Runny nose pain in throat, nostrils, sinus
  sneezing nose bleed hoarseness hacking cough
• Effects appear in 6-24 hrs
• Moderate exposure
• Same as for Mild exposure, plus, loss of voice,
  productive cough
• Severe exposure
• Same as for Moderate exposure, plus
  mild-to-severe breathing difficulty
• Effects appear in 2-6 hrs

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Signs and Symptoms ofVapor Exposure on GI Tract

• Nausea and vomiting
• Effects appear a few hrs to 24 hrs after exposure

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Signs and Symptoms of Liquid Exposure on Skin or
Eye

• Effects similar to those for vapor exposure but
  more severe and appear sooner
• Eyestearing, itching, burning, gritty feeling,
  sensitivity to light, swelling of lids, damage to
  cornea, pain
• Skinreddening, itching, burning, stinging,
  blisters
• Effects most apparent at exposure site

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Signs and Symptoms of Liquid Exposure on Eyes

• Effects same as for vapor exposure, but more
  severe
• For severe exposure
• Symptoms can appear within minutes
• Can result in severe damage to cornea, loss of
  vision, or loss of eye

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Signs and Symptoms of Liquid Exposure on Skin

• Effects similar to those for vapor exposure, but
  more severe
• Tissue damage is deeper
• Tissue death may occur at exposure site
• Injury comparable to third-degree burn

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How Sulfur Mustard Agent Blisters Skin
Normal skin
Reddened skin
Blistered skin
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Sulfur Mustard Blisters
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Other Possible Causes of Signs and Symptoms

• Blister agent signs and symptoms could also apply
  to
• hay fever
• chemical or thermal burns
• heavy tear gas exposure
• poison ivy, poison oak, and other contact
  allergies

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Summary Pop QuizMatch signs symptoms on the
left with the correct cause on the right

• Miosis
• Blisters on skin
• Breathing difficulty
• Extreme sore throat
• Runny nose
• Hearing loss
• Rippling muscles
• Swollen eyelids

• Nerve Agent
• Mustard Agent
• Either
• Neither

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Summary Pop QuizAnswers

• MiosisNerve agent
• Blisters on skinMustard agent
• Breathing difficultyEither
• Extreme sore throatMustard agent
• Runny noseNerve agent
• Hearing lossNeither
• Rippling musclesNerve agent
• Swollen eyelidsMustard agent