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During the Iran-Iraq War, modern medicine was applied to the
treatment of injuries caused by sulfur mustard, tabun, Lewisite, and the biological
agent mycotoxin.[33]
[53]
Although data are limited, there are a number of lessons that we should note. The
most unexpected was the surprisingly low mortality: les than 1% of the estimated
27,000 Iranian chemical casualties.[34]
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Troops with organophosphate exposure fell into four categories.
Those with the greatest exposure died in the field. The number appears to have
been very small even though most of the Iraqi attacks were made against the unprotected
Iranian troops. Those most severely injured who reached medical aid were unconscious
and unresponsive, and they were often in respiratory arrest. The seriously intoxicated
had symptoms of dizziness, disorientation, anxiety, salivation, and respiratory difficulty.
Those with relatively mild symptoms were often physically difficult to manage because
of their disorientation. By far the largest number of casualties required no treatment
other than decontamination. |
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Treatment of mustard exposure during the Iran-Iraq War reflects
the experience gained in the management of burn wounds during the 80 years since
World War I. Treatment begins with early and thorough decontamination. Early in
the course of injury, blistering may not be present, but removal of contaminated
clothing is important to limit the casualty's contact time with the agent. Shaving
of the affected areas followed by washing mechanically removes and dilutes the agent.
Aspiration of blisters, removal of necrotic tissue, and treatment of the skin lesions
with silver sulfadiazine cream forms the basis for treatment of skin injury. Respiratory
exposure to mustard creates its own set of problems. Depending on the degree of
injury, the treatment must be adjusted to the degree of injury. Humidified air or
oxygen helps to prevent airway obstruction. Bronchodilators, mucolytics, and expectorants
are useful. In cases of serious injury, mechanical ventilation with positive end-expiratory
pressure and acid-base balance control are used to support the casualty until the
injuries resolve. Injury to the eyes is treated with irrigation and sodium sulymid.
Pain is treated with systemic medications. Because of weight loss, often in excess
of 10 kg, nutritional support is instituted to help reduce the significant mortality
associated with negative nitrogen balance. After the patient reaches a setting for
definitive care, therapy is divided into two parts: a general supportive treatment
for sepsis and dehydration and treatment to eliminate toxins from the body.[53]
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Significant observations from the Iran-Iraq War include the following: |
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• Decontamination, using soap and water and shaving body
hair, was done early. This protected medical personnel and simplified further treatment. |
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• Comatose casualties of nerve agents who did not have cardiovascular
problems were treated with large doses of atropine, 50 to 200 mg administered intravenously.
Most casualties received 2 mg every 8 hours. Comatose casualties with significant
cardiovascular deterioration (e.g., bradycardia after 2 mg of intravenous atropine)
most often did not survive. |
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• Mustard, although it dates from World War I, continues
to be an important chemical agent. It is a vesicant but also has effects on multiple
organ systems. |
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Adapted from Baker DJ, Rustick JM: Anesthesia for casualties
of chemical warfare agents. In Zaitchuk R, Grande
C (eds): US Army Textbook of Military Medicine, part IV, vol 1. Washington, DC,
US Department of the Army, 1995. |
