Pulmonary Agents

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military materiel (e.g., Teflon7, found in the interior of many military vehicles). The oxides of nitrogen (NOxs) are components of blast weapons or may be toxic decomposition products. Smokes, e.g., HC, contain toxic compounds that cause the same effects as phosgene does. The remainder of this chapter will deal solely with phosgene because it is the prototype of this class of agents; however, the principles of medical management of phosgene exposure also apply to casualties from compounds such as PFIB or NOxs.


HISTORY/MILITARY RELEVANCE

Phosgene was first synthesized by John Davy in 1812. Subsequent development as a potential chemical warfare agent led to the first battlefield use of phosgene (in shells filled solely with phosgene) at Verdun in 1917 by Germany. Later, both sides in the conflict employed phosgene either alone or in mixed-substance shells, usually in combination with chlorine. Although military preparations for World War II included the manufacture and ...

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those capillaries into the interstitial portions of the lung. This effect is from direct contact of phosgene with these membranes; phosgene exposure by other routes, e.g., by intravenous administration, does not cause this damage.

Phosgene-induced leakage of fluid from capillaries into the pulmonary interstitium is normally opposed by lymphatic drainage from the parenchyma, but as the fluid leakage increases, normal drainage mechanisms become progressively overwhelmed. After a 20 minute to 24-hour long asymptomatic or latent period, fluid eventually reaches alveoli and peripheral airways, leading to increasingly severe dyspnea and clinically evident pulmonary edema.


CLINICAL ...

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