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A 65-year-old patient not known to you arrives in your office complaining of dyspnea, chest tightness, and burning of his nose and eyes. He appears rather dyspneic and anxious and is immediately put into an exam room. The patient reports that he had just left a major industrial fire where he had been watching firefighters attempt to control the blaze. He noticed an acrid odor in the air, and when he began coughing, he decided to leave. Within a few minutes he noticed increasing difficulty breathing, and seeing your office, he pulled in to request urgent evaluation. His past medical history is significant only for childhood asthma. He specifically denies any foreign travel and has never been a smoker. On exam, he is tachypneic and tachycardic; you hear wheezes but no crackles. His pulse oximetry finds an SaO2 of 88%. You immediately call for an ambulance. What should you tell the emergency room?

On April 22, 1915, the German army released over 150 tons of chlorine gas downwind toward British and Canadian troops at the Battle of the Marne in Ypres, France (Fig. 23–1). Of the 7,000 soldiers present at the front that day, 5,000 suffered injury or death (see Of Note . . box below). The modern era of chemical weapons had begun. Later that same year on the very same battlefront, the German army released phosgene gas, with far more deadly effects. Further development of chemical weapons proceeded throughout the war, prompting continuous refinement and development of field protective gear in order to limit casualties (Fig. 23–2). The devastating effect of chemical weapons during WWI mobilized the international community and prompted the League of Nations in 1918 to institute the first international treaty to ban chemical weapons. Relative to the most potent nerve agents, pulmonary agents are easy to make and inexpensive to buy. Chlorine and phosgene, two agents first introduced as chemical weapons in WWI, are still available commercially and are used widely in plastics, rubber, and dye industries worldwide. Industrial or transportation accidents with these agents are much more likely to occur than deliberate releases, but their potential as chemical weapons must be considered.

Figure 23–1

United States Marines wearing gas masks on the frontline during WWI.

Courtesy of The World War I Document Archive.

Figure 23–2

British soldier in gas mask.

Courtesy of the World War I Document Archive.

Of Note . .

April 22, 1915, Yypres, France

We knew there was something wrong. We started to march towards Ypres but we couldn’t get past on the road with refugees coming down the road. We went along the railway line to Ypres and there were people, civilians and soldiers, lying along the roadside ...

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