Weapons of Mass Destruction

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Weapons of Mass Destruction Rosen Chapt 195 May 17, 2007 Roy Seitz, M.D. slides by Scott Gunderson PGY-3

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Nuclear & Radiological Events

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Potential Nuclear/Radiological Hazards in the U.S. Basic Radiological Device "Messy" Conventional Bomb Improvised Nuclear Device (IND) 1kT "Bag Nuke" Ballistic Missile Attack 250 kT Nuclear Weapon – "City Killer"

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Radiation Dispersal "Filthy bombs" Low level pollution Acute radiation losses are far-fetched Decontamination and tidy up are primary issues

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Texas Motor Speedway Exercise, November 2004 Three basic crevices distinguished: Casualty/Patient Triage Medical Decontamination (Med Decon) Personal Protective Equipment (PPE)

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Diversion of Nuclear Weapons "We may have lost up to 100 one-kiloton bag estimated atomic bombs" Alexander Lebed (Former) Chief, National Security, USSR

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Energy Partition Standard Fission/Fusion AFRRI, Medical Effects of Nuclear Weapons , "Impact and Thermal Effects" Lecture, 1990.

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Scenario: Washington Mall

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AFRRI, Medical Effects of Nuclear Weapons , "Impact and Thermal Effects" Lecture, 1990.

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Effective Range For Thermal Energy 1 kT Weapon AFRRI, Medical Effects of Nuclear Weapons , "Impact and Thermal Effects" Lecture, 1990.

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AFRRI, Medical Effects of Nuclear Weapons , "Impact and Thermal Effects" Lecture, 1990.

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Atlanta SSE Med Wind 250Kton Fatalities

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Atlanta 250 kiloton SSE wind 7mph

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New York City – 250 kT Nuclear Detonation Mortality Probability 3.9m Affected Red 90% Dark Blue 40% Lt Brown 80% Lt Purple 30% Yellow 70% Dk Purple 20% Green 60% Dk Pink 10% Pale Blue 50% Lt Pink 1%

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What is Fallout? A perplexing blend of more than 200 unique isotopes of 36 components 2 oz of splitting items shaped for every kT of yield. Estimate < 1 micron to a few mm.

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Early Fallout Reaches the ground amid the initial 24 hours after explosion Early aftermath = 50-70% of aggregate radioactivity Highest level of aftermath hazard 7:10 Rule for assessing introduction Hours 1 7 49 Gy/hr 1 0.1 0.01

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Delayed Fallout Arrives following 1 st day Very fine/imperceptible particles Settle in low focuses over the majority of the world's surface 40% of aggregate radioactivity Much lower level of hazard with respect to early aftermath

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Alpha Beta Gamma Neutron 1 m Concrete Ionizing Radiation Any Radiation Consisting of Directly or Indirectly Ionizing Particles or Photons

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3 2 1 Feet Keys to Limiting Exposure Shielding Dense articles confine the measure of radiation that can get to you Distance Dose diminishes quickly as you move far from the source Time Minimizing time spent in vicinity to the source is critical 500 R/hr 125 55

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Radiation Injury Organ Damage Cellular Damage Chemical Damage Free Radicals 10 - 10 Seconds 1. Proteins 2. Layer 3. DNA Tissue harm & Loss of organ capacity Hours to years Seconds to hours

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Distribution of Injuries in a Nuclear Detonation Single Injuries (30% - 40%) Combined Injuries (65% - 70%) Data from Walker RI, Cerveny TJ Eds., Medical Consequences of Nuclear Warfare, TMM Publications, Falls Church, 1989. p 11.

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Hemogram (300 cGy TBI Exposure)

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Absolute Lymphocyte Count more than 48 hours Confirms Significant Radiation Exposure Andrews Lymphocyte Nomogram From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. In Personal Dosimetry for Radiation Accidents. Vienna, International Atomic Energy Agency, 1965, pp 3-16

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Primary Treatment Strategy Treat life debilitating injury first Remove attire/Decontaminate Treat radiation impacts Burn mind Pharmaceutical treatments If surgery is required initial 1-2 days OR 50 days post-presentation

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Decontamination Equipment Hospital Surgical Gown (waterproof) Cap, Face Shield, Booties (waterproof) Double Gloves (inward layer taped) Drapes Plastic Bags Butcher Paper Large Garbage Cans Radiation Signs and Tape

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Decon Agents Dry Removal Disrobing is 80% viable Soap/Shampoo & Water Others ??

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Nuclear Summary Nuclear & Radiological Devices Lots of injury and blaze wounds ARS and tumors Care Issues Bed Capacity/Availability Burn & Trauma mind Decontamination Antidotes Need for broad arranging

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Biological Weapons

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Definition of Bioterrorism Intentional utilization of pathogen or bacterial item to: Cause mischief to people Influence government lead Intimidate or force a regular citizen populace

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Bioterrorism Release Types Overt Release Notice of discharge gave May contain a risk Designed to make frenzy or dread White powder lies May be fabrication or dependable danger Covert Release No notice or danger Difficult to distinguish

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Biological Agent Overview

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Bacillus anthracis Anthrax

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Anthrax-General Endemic in creatures worldwide with intermittent human cases (typically cutaneous) Spores utilized for bioattack Aerosolized straightforwardly or sent in mail/bundles Three structures Cutaneous, Inhalation, GI

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Anthrax – Clinical Features Inhalation Incubation: 2-43 days (might be longer) Prodrome fevers, discomfort, dry hack, trunk torment, dyspnea, myalgia Abrupt onset of fulminant sickness Widened mediastinum, pleural emanations; meningitis in ~50% Actual pneumonia phenomenal

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Inhalational Bacillus anthracis — US record case

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Anthrax – Clinical Features Cutaneous Incubation: 1 to 7days (might be up to 12 days) Erythematous papule  ulcer  trademark dark eschar with encompassing erythema and edema Regional adenopathy and systemic side effects (e.g., fever, disquietude) may create

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Cutaneous Anthrax

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Anthrax – Clinical Features Gastrointestinal Incubation period 1-7 days Not likely after a bioattack Presents as febrile ailment with wicked the runs

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Anthrax Diagnosis Blood societies normally constructive in <24h Gram recolor/Dx of pleural liquid or CSF Sputum is normally NOT constructive by stain/culture Fever and extended mediastinum on CXR/CT exceptionally suggestive Cutaneous malady culture liquid from under eschar Nasal swabs are a poor test

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Anthrax in CSF — US file case

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Anthrax - Treatment Ciprofloxacin 400 mg IV q12h 10-15 mg/kg for youngsters different fluoroquinolones most likely likewise powerful OR Doxycycline 100 mg IV q12h 2.2 mg/kg for kids PLUS 1 or 2 extra anti-toxins (clindamycin, rifampin, vancomycin, penicillin, chloramphenicol, imipenem, clarithromycin)

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Anthrax - Treatment Switch to oral treatment when clinically fitting 60 days treatment (or until third measurements immunization) ciprofloxacin 500 mg PO BID or doxycycline 100 mg PO BID

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Prophylaxis and Infection Control Prophylaxis Ciprofloxacin 500 mg PO BID (10-15 mg/kg for kids ) or Doxycycline 100 mg PO BID (2.2 mg/kg for kids) Continue for 60 days (? 100 days) Vaccine accessible for DOD strengths Infection Control Standard obstruction safeguards are required

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Vaccine 17

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Yersinia pestis Plague Source: www.cdc.gov Yersinia pestis

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Plague - General Endemic in creatures many parts of the world Including prairie puppies in the southwestern us High potential as a BT operator Endemic frame Spread to people by means of an insect vector Bubonic type of the ailment Bioattack Most likely aerosolized Pneumonic torment

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Plague – Clinical Features Following Bioattack 1-6 day hatching Abrupt onset High fever Chills, discomfort Cough with bleeding sputum Sepsis Severe quickly dynamic pneumonia

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Bubonic Plague Source: www.cdc.gov Buboes

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Plague - Diagnosis CXR with inconsistent penetrates Culture of blood and sputum Need to educate the research facility in the event that you speculate torment Gram stain may demonstrate trademark "security stick" bipolar recoloring

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Plague Source: www.cdc.gov Yersinia pestis in blood

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Plague pneumonia

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Plague - Treatment Preferred Streptomycin 1 g IM q12h 15 mg/kg/measurement for kids Avoid in pregnant ladies Gentamicin 5 mg/kg IM or IV qd or 2 mg/kg stack the 1.7 mg/kg q8h for youngsters utilize 2.5 mg/kg q8h Alternative Doxycycline 100 mg IV q12h 2.2 mg/kg/dosage q12h for kids Ciprofloxacin 400 mg IV q12h different fluoroquinolones presumably viable for kids 15 mg/kg/dosage q12h

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Plague - Infection Control Prophylaxis Doxycycline 100 mg PO offer 2.2 mg/kg for kids Ciprofloxacin 500 mg PO offer 20 mg/kg for kids different fluoroquinolones most likely viable Treat for 7 days Isolation Droplet safety measures

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Smallpox Source: www.cdc.gov

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Smallpox - General One of the deadliest malady known Mortality rate of 30% US quit inoculating in 1972 Declared destroyed by WHO 1980 Bioattack aerosolized infection or by introduction to intentionally contaminated fear mongers

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Smallpox - Clinical Features Incubation period 7-17 day (normal 12d) Severe prodrome 2-3 day of fever, extreme myalgias, surrender, occ. n/v, delerium 10% with light facial erythematous rash Distinctive rash at first on face and furthest points including palms and soles spreads to trunk

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Small Pox - Clinical Features Rash macules  papules  vesicles  pustules not at all like chicken pox, sores don't show up in "products" All sores in zone same phase of advancement Lesions are firm, profound, much of the time umbilicated Rash scabs over in 1-2 weeks scars after scabs discrete

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Smallpox Source: www.cdc.gov

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Smallpox versus Chickenpox