Emergency Preparedness and Poisonings Chapter 12

The Nature of Bioterrorism  After 9/11 attacks, awareness of outbreaks and treatments expanded to include bioterrorism  Bioterrorism – intentional use of biologic agents, chemical substances, or radiation to cause widespread harm or illness  Goal: to create public panic and to cause as many casualties as possible

Emergency Preparedness  Not a new concept  Hospitals required to have disaster plans  Plans have changed recently to include how a health care system might change during a crisis  Cooperation between different health care professionals essential during bioterrorist attack

Key Roles of Nurse in Preparing for and Responding to Bioterrorist Act  Education  Emergency management  Resources  Contacts in health and law enforcement  Diagnosis and treatment  Signs, symptoms, and treatment of chemical/biological agents  Planning  Emergency-management plans

Strategic National Stockpile (SNS)  Managed by the US Centers for Disease Control and Prevention (CDC)  Stockpile consists of antibiotics, vaccines, and medical, surgical, and client supplies  Designed to ensure immediate deployment of essential medical materials in case of biological or chemical attack

Anthrax  Used as part of bioterrorist attacks in 2001  Caused by Bacillus anthracis.  Can cause serious damage to body tissues

Transmitted to Humans  Exposure to open wound  Through contaminated food  By inhalation  Causes disease by emission of two types of toxins, edema toxin and lethal toxin

Anthrax Survivability  Bacterium can form spores  Spores can be viable in soil for hundreds or thousands of years  Resistant to drying, heat, and some harsh chemicals  Found in contaminated animal products such as wool, hair, dander, and bonemeal, but it can also be packaged in other forms

Clinical Manifestations of Anthrax  Cutaneous anthrax  Small skin lesions that turn into black scabs  Gastrointestinal anthrax  Sore throat, difficulty swallowing  Cramping, diarrhea, abdominal swelling

Clinical Manifestations of Anthrax (cont'd)  Inhalation anthrax  Initially fatigue and fever  Then persistent cough and shortness of breath

Treatment for Anthrax  Ciprofloxacin (Cipro)  Prophylaxis—500 mg PO, every 12 hours for 60 days  Confirmed case—400 mg IV, every 12 hours  Other antibiotics that are effective  Penicillin, vancomycin, ampicillin, erythromycin, tetracycline, and doxycycline

Treatment for Anthrax (cont'd)  Combination of ciprofloxacin and doxycycline approved  For inhalation anthrax  Worried public discouraged from use of antibiotics where anthrax has not been found  Can promote antibiotic resistant strains  Vaccines were approved in 1970s, but little used because of little incidence of anthrax infection  Recommended for very few people, such as laboratory staff that work with anthrax

Nerve Agents  Can cause convulsions and loss of consciousness within seconds, and respiratory failure within minutes  Relate to overstimulation by the neurotransmitter acetylcholine  Blocks AchE, increasing the action of acetylcholine in the synaptic space

Ionizing Radiation  Can result from hundreds of different radioisotopes created by nuclear explosion  Survivors: High risk for developing cancers, particularly leukemia

Treating Radiation Exposure  Symptoms some of the most difficult to treat pharmacologically  potassium iodide (KI) tablets one of the few recognized approaches  Prevents Radioactive Iodine (I-131) from entering thyroid gland  Protects only thyroid gland

Poisonings and Toxicity Treatment  Nurses must be familiar with basic elements of toxicity treatment  Pharmacologic agents approach toxicity when doses exceed recommended range  Poisonings intentional or accidental

Basic Supportive Care for Toxicity  One of the first elements of toxicity treatment  Maintain airway, breathing, and circulation  Proper blood glucose levels  Seizures  Agents may be used to facilitate removal of some toxins

Surface Decontamination  Remove clothes  Flush with water  Soap-and-water and alcohol Washes for undamaged skin

Poisoning Treatments  Gastric lavage and aspiration  Patient has ingested a potentially life-threatening amount of poison  Must be done within 60 minutes  Single-dose activated charcoal  If poison is carbon-based  Greatest benefit within 60 minutes

Poisoning Treatments  Whole-bowel irrigation  Potentially toxic ingestions of sustained-release or enteric-coated drugs  toxic ingestions of iron, lead, zinc, or illicit drugs  Specific antidotes counter the effects of poisons or toxins in a number of cases

Table 12.6 (cont'd) Examples of Specific Antidotes for Overdosed Substances or Toxins