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Blister Agents (VESICANTS) FACT SHEET HEALTH CARE WORKERS Examples: Mustard (H), Distilled Mustard (HD), Nitrogen Mustard (HN1, HN2, HN3), Lewisite (L) WHAT ARE BLISTER AGENTS (VESICANTS)? Blister Agents or mustard gases, refer to several manufactured chemicals, including sulfur mustard and Lewisite, that do not occur naturally in the environment Mustard gas is actually a liquid and is not likely to change into a gas immediately if it is released at ordinary temperatures. As a pure liquid, it is colorless and odorless, but when mixed with other chemicals, it looks brown and has a garlic-like smell. Although volatility is low, vapors can reach hazardous levels during warm weather. Sulfur mustards are absorbed by the skin, causing erythema and blisters. Ocular exposure to these agents may cause incapacitating damage to the cornea and conjunctiva. Inhalation damages the respiratory tract epithelium and may cause death. Characteristically, patients complain of eye, skin and lung irritation. WHAT ACTIONS ARE TAKEN FOR PATIENTS WHO PRESENT WITH POTENTIAL BLISTER AGENT EXPOSURE Decontamination of the eyes and skin within 1 or 2 minutes after exposure is the most effective means of decreasing tissue damage. WHAT ARE THE SYMPTOMS OF BLISTER AGENTS? • • • • • • • • • • Eye burning, pain Reddening of skin Blistering (especially around sweaty parts of the body) Convulsions Respiratory failure Sluggishness Apathy Lethargy Coughing Bronchitis HOW ARE BLISTER AGENT DIAGNOSED? Routine laboratory studies should be done for all patients requiring admission. These include CBC, glucose, and serum electrolytes. Chest x-ray and pulse oximetry (or ABG measurements) are recommended for inhalation exposures. A test for urine thiodiglycol, a metabolite of mustard, can be performed at specialized laboratories, but is not a routine laboratory measure. CAN BLISTER AGENTS BE SPREAD FROM PERSON TO PERSON? People whose skin or clothing is contaminated with sulfur mustard can contaminate rescuers and others by direct contact or through off-gassing vapor. WHAT MEDICAL TREATMENT IS GIVEN TO PATIENTS EXPOSED TO BLISTER AGENT? Patients arriving immediately from the scene of exposure to sulphur mustard are not likely have signs. Immediate symptoms may be seen with Lewisite exposure. There is no antidote for sulfur mustard toxicity. Decontamination of all potentially exposed areas within minutes after exposure is the only effective means of decreasing tissue damage. There is no antidote for sulfur mustard toxicity. There is an antidote for Lewisite, called BAL or British Antilewisite, but its use is reserved for severe poisoning. Medical treatment is supportive and similar to that provided for thermal burns. DO YOU NEED TO ISOLATE A PATIENT WITH BLISTER AGENT EXPOSURE? Yes. Prior to decontamination the patient should be isolated to prevent secondary exposure to medical staff. sjm