This book provides sought-after guidance to primary care physicians on preparing for and responding to terrorist events. Chapters offer a fundamental understanding of the epidemiology and relevant clinical aspects of diseases caused by biological agents (anthrax, plague, smallpox, botulism, tularemia, and hemorrhagic viruses), chemical agents (nerve and blister), and radiological agents. The text details how to detect terrorist-caused illness as early as possible, how to provide defensive or preventive therapy, and how to triage and treat ill patients. Emphasis is placed on addressing both the physical and psychological impact on patients and providers. The author also examines how to work effectively with public health officials at the local, state, and national levels on the delivery of preventive and therapeutic measures. Surveillance activities, plans for handling mass casualties, and responding to concerns about risk are discussed as well. The practical approach is also applicable to accidental and natural disasters. This timely resource is invaluable for primary care physicians who want to better understand their role for patients and the public in emergency preparedness. Book jacket.

Emergency Preparedness for the Primary Care Physician	p. 1
Brief History of Biological and Chemical Warfare	p. 1
Recent Events	p. 3
References	p. 5
Biological Terrorism	p. 7
Features of Biological Terrorist Attacks	p. 7
Biological Agents Terrorists Are Likely to Use	p. 9
Anthrax	p. 10
Microbiology and Epidemiology	p. 10
Anthrax as a Biological Weapon	p. 11
Plague	p. 32
Microbiology and Epidemiology	p. 32
Plague as a Biologic Weapon	p. 34
Clinical Presentation and Diagnosis	p. 35
Bubonic Plague	p. 35
Septicemic Plague	p. 36
Pneumonic Plague	p. 36
Treatment	p. 38
Prevention	p. 40
Vaccine and Postexposure Prophylaxis	p. 40
Infection Control	p. 41
Smallpox (Variola)	p. 41
Microbiology and Epidemiology	p. 41
Smallpox as a Biological Weapon	p. 43
Clinical Presentation	p. 44
Ordinary Smallpox	p. 44
Modified Smallpox	p. 46
Flat (Malignant) Smallpox	p. 46
Hemorrhagic Smallpox	p. 47
Variola Sine Eruptione and Subclinical Smallpox	p. 47
Diagnosis	p. 47
Differentiating Smallpox from Other Rash Illness, Especially Varicella (Chickenpox)	p. 47
Case Management and Reporting	p. 50
Infection Control	p. 51
Smallpox Laboratory Investigation	p. 52
Treatment	p. 53
Prevention	p. 54
Vaccine: History and Effectiveness	p. 54
Adverse Events Following Smallpox Vaccination	p. 56
Local Reactions	p. 56
Mild Systemic Reactions	p. 56
Inadvertent Inoculation	p. 57
Generalized Vaccinia	p. 58
Eczema Vaccinatum	p. 58
Myopericarditis	p. 59
Progressive Vaccinia	p. 60
Postvaccinial Encephalitis	p. 61
Fetal Vaccinia	p. 61
Vaccine Administration	p. 61
Contraindications to Smallpox Vaccine	p. 63
Preevent Smallpox Vaccine	p. 64
Postexposure Vaccine for Prevention of Disease Transmission	p. 68
Botulism	p. 69
Microbiology and Epidemiology	p. 69
Botulinum Toxin as a Biological Weapon	p. 70
Clinical Presentation and Diagnosis	p. 71
Treatment	p. 77
Prevention	p. 79
Tularemia	p. 81
Microbiology and Epidemiology	p. 81
Tularemia as a Biological Weapon	p. 82
Clinical Presentation and Diagnosis	p. 83
Treatment	p. 87
Contained Casualty Situation	p. 87
Mass Casualty Situation	p. 89
Prevention	p. 90
Tularemia Vaccine	p. 90
Postexposure Antibiotic Prophylaxis	p. 90
Infection Control	p. 91
Hemorrhagic Fever Viruses	p. 91
Microbiology and Epidemiology	p. 91
Arenaviruses	p. 92
Bunyaviruses	p. 93
Filoviruses	p. 93
Flaviviruses	p. 94
Hemorrhagic Fever Viruses as Biological Weapons	p. 94
Viral Hemorrhagic Fever: Clinical Presentation and Diagnosis	p. 95
Treatment	p. 98
Infection Control	p. 100
Prevention	p. 103
Special Considerations: Intentional Contamination of Food or Water with Biologic Agents	p. 104
References	p. 106
Chemical Terrorism	p. 111
Features of Chemical Terrorist Attacks	p. 111
General Precautions in Responding to Chemical Attacks	p. 113
Chemical Agents Terrorists Are Likely to Use	p. 119
General Considerations	p. 119
Nerve Agents	p. 120
Nerve Agents as Chemical Weapons	p. 120
Mechanism of Action	p. 121
Nerve Agent Exposure: Clinical Presentation and Diagnosis	p. 121
Treatment	p. 124
Nerve Agent Intoxication: Prevention	p. 128
Vesicant Agents: Nitrogen and Sulfur Mustards, Lewisite, and Mustard-Lewisite Mixture	p. 128
Vesicant Agents as Chemical Weapons	p. 128
Mechanism of Action	p. 129
Sulfur and Nitrogen Mustard Vesicant Exposure: Clinical Presentation and Diagnosis	p. 129
Lewisite Vesicant Exposure: Clinical Presentation and Diagnosis	p. 134
Treatment	p. 135
Prevention	p. 139
Blood Agents: Cyanide (Hydrogen Cyanide, Cyanogen Chloride, Sodium Cyanide, Potassium Cyanide)	p. 139
Blood Agents as Chemical Weapons	p. 139
Mechanism of Action	p. 139
Clinical Presentation and Diagnosis	p. 140
Treatment	p. 141
Pulmonary Agents	p. 143
Pulmonary Agents as Chemical Weapons	p. 143
Mechanism of Action	p. 144
Clinical Presentation and Diagnosis	p. 145
Treatment	p. 147
Postexposure Prophylaxis	p. 148
RICIN	p. 149
Ricin as a Chemical Weapon	p. 149
Mechanism of Action	p. 151
Clinical Presentation and Diagnosis	p. 151
Treatment	p. 153
Prevention	p. 153
Special Considerations: Intentional Contamination of Food or Water with Chemical Agents	p. 154
References	p. 155
Radiological Terrorism	p. 159
Features of Radiological Terrorist Attacks	p. 159
Simple Radiologic Devices	p. 160
Radiologic Dispersal Devices	p. 161
Nuclear Reactor Sabotage	p. 162
Improvised Nuclear Devices and Stolen Nuclear Weapons	p. 163
Radiation Injury: Mechanism of Action	p. 163
Types of Ionizing Radiation	p. 164
Nonradiation Hazards from Improvised Nuclear Devices and Nuclear Detonations	p. 165
Radiation Injury: Clinical Presentation	p. 166
Acute Radiation Syndrome	p. 166
The Hematopoietic Syndrome	p. 169
The Gastrointestinal Syndrome	p. 172
The Cerebrovascular Syndrome	p. 172
The Cutaneous Syndrome	p. 173
Radiation Injury: Diagnosis, Triage and Exposure Assessment	p. 173
Triage	p. 179
External Decontamination	p. 179
Biodosimetry	p. 180
Internal Decontamination	p. 186
Radiation Injury: Treatment	p. 189
Treatment of the Hematopoietic Syndrome	p. 189
Transfusion	p. 193
Stem Cell Transplantation	p. 193
Supportive and Comfort Care	p. 195
References	p. 196
Mental Health and Terrorism	p. 197
Epidemiology	p. 198
Diagnosis of Mental Health Symptoms Following Terrorist Attacks	p. 202
Children	p. 203
Anxiety and Somatization Disorders	p. 204
Posttraumatic Stress Disorder	p. 206
Treatment of Mental Health Conditions Following Terrorist Attacks	p. 208
Emergent Treatment	p. 208
Counseling and Education	p. 209
Counseling Children and Their Parents	p. 210
Psychological Treatment	p. 213
Pharmacologic Treatment	p. 214
Prevention	p. 216
References	p. 217
The Primary Care Physician's Role in Supporting the Public Health Response to Biological, Chemical, and Radiological Terrorism	p. 221
Surveillance and Reporting	p. 221
HIPAA Privacy Rules and Physician Reporting	p. 223
Syndromic Surveillance	p. 226
Responding to the Patient Surge Following a Terrorist Attack	p. 229
Beyond the Office: Volunteering to Help	p. 232
The Medical Reserve Corps	p. 233
Disaster Medical Assistance Teams	p. 234
Primary Care Role in Responding to Biological, Chemical, and Radiological Terrorism	p. 235
References	p. 236
Index	p. 239
Table of Contents provided by Ingram. All Rights Reserved.

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Biological, Chemical, and Radiological Terrorism

9780387472317

0387472312

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