Care of Casualties

Eyes

Individuals with mustard conjunctivitis will require application of a steroid antibiotic eye ointment. The recommended medication is dexamethasone sodium phosphate-neomycin ophthalmic ointment for application. This drug decreases the infl ammation and has antibacterial effects.

Systemic narcotic analgesics are recommended for eye pain.

WARNING! Never bandage the eyes when affected, since eyelids may stick together and the secretions will not have a means to drain. The resulting accumulation of secretions can lead to infection and corneal ulcerations. Individuals presenting with blister agent conjunctivitis will require immediate medical treatment by an ophthalmologist.

Skin

Individuals presenting with erythema (reddening of the tissues) painful enough to limit motion in a limb will need immediate medical treatment.

The treatment for erythema is the same used for the itching and burning sensations that accompany exposure to blister agents. Application of a topical steroidal cream or calamine lotion will provide temporary relief.

Normally erythema progresses to blister formation (vesication). Size and number of blisters depends on the severity of exposure, skin condition (sweaty and moist, or dry) at the time of exposure, and location of the exposure on the individual.

Blisters the size of a quarter or smaller or should be left intact, if possible. The blister, which is fi lled with a sterile fl uid, will act as a protective cover over the wound and provides good protection from infection. Small, unbroken blisters should be covered with a petrolatum gauze bandage. The dressing should be changed every three to four days. The blister fluid does not contain live agent.

Large blisters should be drained, and blisters that have broken should have the ragged roof of the blister removed. The area of the open blister should be cleaned with tap water or saline and a petrolatum gauze bandage applied. The primary concern when treating blisters of any size is prevention of infection.

Initial blister formation may be slight, but over time could progress to large blisters and infection. The individual should be given a topical antibacterial cream such as 10% mafenide acetate or silver sulfadiazine burn cream and instructed to apply a 1/8 inch layer to the blister four times a day. The area should then be covered by a petrolatum gauze bandage.

Lungs

The casualty with any sign or symptom of respiratory exposure should get prompt medical attention. First responders cannot determine damage to the larynx or trachea. Seek immediate medical assistance.