WHY SARIN GAS IS SCARY...

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So, politics aside, let's examine why Sarin Gas and other chemical agents of warfare are horrific things and how they kill.  Sarin Gas was discovered by a German chemist in 1937 as an insecticide.  The Nazi's in all their wisdom (sarcasm) discovered that in addition to serving as an effective pesticide, it was also an efficient way to kill people.  In the United States, exposures to this chemical is rarely seen.  The only place you may come across an exposure to a chemical similar to Sarin gas is in an exposure to strong pesticides which are used in the farming industry. These strong pesticides are known as organophosphates and exposure to them causes organophosphate poisoning.  Sarin gas has been used in attacks outside of the United States with the most recent one in Syria.  It was also used in two separate attacks in Japan. 

Sarin gas works by attacking your nervous system.  It works by messing with the chemicals that allow your nerves to communicate. Specifically, it prevents the breakdown of the chemicals that cause your nerves to fire, resulting in excessive firing of certain nerves.   In the emergency department, we are taught to identify exposure to such chemicals by the acronym SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI distress and Emesis).  This causes excess secretions from every orifice. The deadliest of the side effects are the lungs where you will get excess lung secretions (bronchorrhea) and spasm of the muscles in the lungs (bronchospasm).  These are the two things that will eventually cause you to die from exposure to Sarin Gas. 

The symptoms you feel with exposure to this will be nasal congestion followed rapidly by shortness of breath and then nausea.  Depending on level of exposure, death will typically result within a few minutes from the chemicals effects on the lungs. According to the center for disease control (CDC) It's important to note that the vapors can be released from someone’s clothes for approximately 30 minutes after exposure so decontamination when caring for these patients is extremely important.  Don't ask me who has the pleasure of working with this stuff to do those tests, but that is apparently the length of time it lasts. 

The treatment after exposure is with a medication called Atropine or Pralidoxime, which can help reverse the effects. There are other medications as well but these are reserved for patients with imminent death.  Most people survive mild exposures without complication, any other level of exposure will typically result in death.  

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-Dr. Paul