APPENDIX E: SEVERE VESICANT INHALATION PROTOCOL

Severe Vesicant Inhalation Protocol

- Mustard symptoms will be delayed, if severe airway complications arise it will most likely be during PFC. Lewisite injury will be immediate.
- Deep Tracheal Suctioning, Bronchoscopy, RSI, and Mechanical Ventilation also may be required.
- IV/IO 8mg Dexamethasone (preferred) or 125 mg Solu-Medrol
- Albuterol + NAC + Lidocaine

Combine in a nebulizer q 4-6 hrs:

(1) Albuterol bullet, 2.5mg in 3mL ,

(2) NAC 20%, 3mL

(2) Lidocaine 4% or 2%, 1 mL

Complications & Adverse Effects: Lidocaine can create an airway protection issue if casualty has altered level of consciousness.

There is a potential for pneumonitis to develop after vesicant lung injury. Antibiotics (azithromycin, levofloxacin or moxifloxacin), should be used in the setting of suspected infection and not prophylactically