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CBRNE - Incapacitating Agents, Opioids/Benzodiazepines - Follow-Up

Author Information and Disclosures

Follow-Up

Further Inpatient Care:
  • See Emergency Department Care. Keep symptomatic patients who were exposed to the aerosolized agents in a monitored setting until their symptoms completely resolve. Use of maintenance intravenous fluids may be necessary. Prolonged intoxication may occur depending on the dose of the agent absorbed.

Transfer:

  • Any health care facility that is unable to adequately monitor a patient intoxicated with the agents should consider transfer to a facility that can care for such patients.
  • Smaller health care facilities may be overwhelmed if a large-scale exposure occurs. Disaster-plan implementation and appropriate transfer of patients to less-stressed facilities may be necessary.

Complications:

  • Anoxic brain injury: If an exposed person becomes comatose and loses his or her ability to maintain ventilatory function, hypoxia may develop and lead to anoxic brain injury.
  • Aspiration pneumonia: The inability of an exposed patient to maintain his or her airway may result in aspiration of gastric contents into the lungs.
  • Rhabdomyolysis: If a person exposed to these agents develops profound somnolence, pressure tissue necrosis may occur, and rhabdomyolysis may develop. If this remains undiagnosed, myoglobinuric renal failure may develop.

Prognosis:

  • The prognosis is good for patients exposed to aerosolized benzodiazepines or opioids if no secondary injuries, such as the complications noted above, develop. Once patients are removed from the exposure and the absorbed drug is metabolized, they should become more lucid. No long-term effects are expected from these agents themselves.

Patient Education:

Miscellaneous

Medical/Legal Pitfalls:
  • Few pitfalls exist from a medicolegal standpoint. Decontaminating patients and avoiding secondary contamination of health care workers is paramount. If a physician demonstrates good supportive care as discussed in this article, the risk of litigation against the caregivers should be minimal.

Special Concerns:

  • Patients at the extremes of age may be more susceptible to toxicity from these agents. Other factors expected to predispose a patient to toxicity and complications include preexisting health problems (eg, chronic obstructive pulmonary disease [COPD]), volume depletion, and concurrent use of medications with sedative properties.
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Bibliography

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Synonyms And Related Keywords

incapacitating agent; opioid; fentanyl; carfentanil; alfentanil; sufentanil; benzodiazepine; diazepam; chemical warfare agents; chemical, biological, radiological, nuclear, and explosive threat agents; chemical weapons; benzodiazepine toxicity; opioid toxicity

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Author Information and Disclosures

Author: Christopher P Holstege, MD, FACEP, FACMT, Associate Professor of Emergency Medicine and Pediatrics, University of Virginia; Director, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Ctr, Associate Medical Toxicology Fellowship Director, VA Dept of Health

Coauthor(s): Alexander Baer, MD, Staff Physician, Department of Emergency Medicine, University of Virginia School of Medicine

Christopher P Holstege, MD, FACEP, FACMT, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Association for the Advancement of Science, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Christian Medical and Dental Society, Medical Society of Virginia, Society for Academic Emergency Medicine, and Wilderness Medical Society

Editor Information

Editor(s): Suzanne White, MD, Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Robert G Darling, MD, FACEP, Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Director, Center for Disaster and Humanitarian Assistance Medicine

 
 
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