Blood Agents

Blood agents such as hydrogen cyanide and cyanogen chloride have a direct effect on cellular metabolism resulting in asphyxiation through alterations in hemoglobin. Cyanide  is an agent that has profound systemic effects to the human body. It is commonly used in the mining of gold and silver and in the plastics of dye industries. In 1984, the Union Carbide pesticide plant in Bhopal India, inadvertently released large amounts of cyanide which resulted in one of the largest industrial disasters resulting in hundreds of deaths and injured.

Blood agents such as cyanide, when accidentally released in large quantities or when used as a chemical weapon, is universally identified as having an aromatic smell of bitter almond. In house fires, cyanide is released during the combustion of plastics, rugs, silk, furniture and similarly related construction materials. There is a significant correlation between blood cyanide and carbon monoxide levels in patients after inhaling so much fumes in a fire related disaster, and in many cases the cause of death is due to cyanide poisoning superseding carbon monoxide poisoning.

Exposure to Blood Agents

Blood agents often work its way through ingestion and inhalation. When used as a chemical weapon, blood agents are usually disseminated as aerosols which take effect through inhalation which often prove to be one of the most deadliest ways to inflict damage to the human body. Because of their volatility, they are very lethal when released in confined areas than in open areas. Cyanide compounds, in particular occur in minute amounts in the natural environment and in cigarette smoke. They are also commonly used in industrial processes as well as a common ingredient in the manufacture of pesticides.

Clinical Manifestations of Blood agents

Blood agents such as cyanide when ingested, inhaled, or absorbed through the skin and mucous membranes result in serious clinical symptoms which can lead to permanent disability which often prove to be fatal when not properly managed. Cyanide in particular is one of the most potent and toxic blood agents which. Cyanide is protein-bound and once in is freely inside the systemic circulation it basically impedes and inhibits aerobic metabolism leading to respiratory arrest due to diaphragmatic muscle failure, cardiac arrest and death. Inhalation of blood agents such as cyanide often results in tachypnea, flushing, tachycardia, non-specific neurologic symptoms, stupor, coma and seizure preceding respiratory arrest.

Treatment for Blood Agents

Rapid administration of amyl nitrate, sodium nitrite and sodium thiosulfate is essential to the successful management cyanide exposure and similar blood agents. Victims exposed to cyanide must be intubated and placed on a ventilator.  Amyl nitrate pearls need to be crushed and placed in the ventilator reservoir to assist in inducing methemoglobinemia (increase in hemoglobin production). It is important to note that cyanide as a blood agent has 20-25% higher affinity in binding with hemoglobin hence rapid and successive induction of the above mentioned medication is essential to help maintain good oxygenation of all vital organs in the body. Although this effort may be life-saving, the above mentioned emergency medications have side effects: Sodium nitrite for example can lead to severe hypotension and thiocyanate can induce vomiting and psychosis. Due care must be observed at all times when administering emergency medications for blood agents since an overdose of these medications can severely damage the liver and kidneys.

 

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