Biological Agents
Category A (highest priority): Anthrax (Bacillus anthracis, flu-like symptoms, widened mediastinum, meningitis). Smallpox (fever, rash pustules same stage, contagious, no treatment). Plague (Yersinia pestis, pneumonic, fever, hemoptysis, sepsis). Botulism (descending flaccid paralysis, cranial nerves first, no fever). Tularemia (Francisella tularensis, fever, ulcer, lymphadenitis). Viral hemorrhagic fevers (Ebola, Marburg, Lassa). Category B: Q fever, brucellosis, food/water safety threats.
Chemical Agents
Nerve agents (sarin, soman, VX, tabun): organophosphates, cholinergic crisis (SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis), pinpoint pupils, bronchospasm, seizures, respiratory failure. Treatment: atropine, pralidoxime (2-PAM), diazepam, decontamination. Blister agents (mustard, lewisite): skin/eye/respiratory burns, delayed onset. Choking agents (chlorine, phosgene): pulmonary edema. Blood agents (cyanide): cellular hypoxia, bitter almond, rapid death.
Nursing Response
Recognize: unusual clusters, unusual symptoms, rapid deterioration. Report: to public health, infection control. PPE: appropriate for agent. Decontamination: strip (remove clothing, 90% contamination), wash with soap and water, separate clean/dirty zones. Isolation: appropriate for agent (anthrax: standard, smallpox: airborne + contact). Treatment: specific antidotes (atropine/2-PAM for nerve agents, hydroxocobalamin for cyanide). Psychological: panic, mass psychogenic illness. Education: community, healthcare workers. Surveillance: report unusual patterns.
Important Notes
- Nerve agents cause cholinergic crisis (SLUDGE): Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis — treat with atropine and pralidoxime (2-PAM).
- Smallpox rash: all lesions at the same stage (unlike chickenpox which has lesions at different stages) — key diagnostic feature.
Clinical Tips
- Decontamination: remove clothing first (removes 90% of contamination), then wash with soap and water — never send contaminated patients to ED without decontamination.
- Cyanide: bitter almond smell, rapid collapse, cherry-red skin (oxygen stays in blood but cannot enter cells) — treat with hydroxocobalamin.
Summary
Bioterrorism response requires recognizing Category A agents (anthrax, smallpox, plague, botulism), treating chemical exposures (nerve agents: atropine/2-PAM), and proper decontamination.
