This document focuses on toxic inhalational injury and treatment.
The number and types of pulmonary toxicants available to the military increased substantially during World War I. At least 14 different respiratory agents were used, as well as obscurants (smokes), harassing agents (chloracetone), and vesicants (mustard) that could cause pulmonary injury. Only a handful of these toxicants still exist in stockpiles around the world today, but several are currently produced in large quantities for industrial purposes. These chemical agents pose a very real threat to military personnel. Toxic inhalational injury poses a two-fold problem for military personnel: no specific therapy exists for impeding or reversing toxic inhalant exposures; and toxic inhalational injury can cause large numbers of casualties that can significantly burden medical facilities. The processes that develop in the upper and lower respiratory tract can greatly incapacitate a casualty or result in death within minutes of exposure. It is therefore imperative that adequate control of the casualty's airways be maintained. Medical personnel should look for hypoxia (inadequate oxygen intake), hypercarbia, and pulmonary edema, all of which are signs of possible toxic inhalant exposure. Infectious bronchitis or pneumonitis is a frequent complication. The importance of chronic health problems that occur postexposure to toxic inhalants is a contentious subject because of the nebulous signs and symptoms that mimic degenerative diseases, such as emphysema, common to the general population. 66 references