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Previous Volume 350:800-808 February 19, 2004 Number 8 Next

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Acute chemical emergencies can occur as a result of an industrial disaster,^1,2 occupational exposure,^3,4 recreational mishap,⁵ natural catastrophe,⁶ chemical warfare,^7,8 and acts of terrorism.^9,10 This article reviews the health effects most commonly associated with the short-term release of industrial and environmental substances and with the use of chemical weapons. We emphasize the application of empirical principles and the recognition of four clinical syndromes, or "toxidromes," that are applicable to most scenarios of accidental release of chemicals and deliberate release as in acts of chemical terrorism. The classes of substances that correspond to these clinical syndromes are asphyxiants (e.g., cyanide), cholinesterase . . . [Full Text of this Article]

General Principles

Asphyxiants

Cholinesterase Inhibitors

Respiratory Tract Irritants

Vesicants and Skin Caustics

Community Preparedness

Source Information

From the Cambridge Health Alliance, Harvard Medical School, Cambridge, Mass. (S.N.K.); the Department of Environmental Health, Occupational Health Program, Harvard School of Public Health, Boston (S.N.K., D.C.C.); the Pulmonary–Critical Care Unit, Massachusetts General Hospital and Harvard Medical School, Boston (D.C.C.); and the Northeast Specialty and Rehabilitation Hospital–Center for Occupational and Environmental Medicine, Braintree, Mass. (D.C.C.).

Address reprint requests to Dr. Kales at the Cambridge Health Alliance, Department of Medicine, Occupational and Environmental Health, 1493 Cambridge St., Cambridge, MA 02139, or at skales@challiance.org.

Related Letters:

Acute Chemical Emergencies
Newmark J., Hurst C. G., Nogué-Xarau S., Dueñas A., Burillo G., Kales S. N., Christiani D. C.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:2102-2104, May 13, 2004. Correspondence

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