Phosgene

Antidotes - there are no specific antidotes for phosgene.

Supportive

Intubate the trachea in cases of coma or respiratory compromise, or to facilitate removal of excessive pulmonary secretions. If not possible, perform cricothyroidotomy or place 14 gauge angiocatheter in crico-thyroid membrane (if equipped and trained to do so). Frequent suctioning of the airways will be necessary to remove mucous secretions.

Link - placement of 14 gauge angiocatheter in cricothryroid membrane

Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.

Consider racemic epinephrine‡ aerosol for children who develop stridor. Dose 0.25 - 0.75 mL of 2.25 % racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.

Patients who are comatose, hypotensive, or are having seizures or cardiac arrhythmias should be treated according to advanced life support (ALS) protocols.

Enforce rest - Even minimal physical exertion may shorten the clinical latent period and increase the severity of respiratory symptoms and signs in a lung-damaging agent casualty. Physical activity in a symptomatic patient may precipitate acute clinical deterioration and even death. Strict limitation of activity are strongly recommended for patients suspected of having inhaled phosgene.

• Link to Basic and Advanced Life Support
• Link to Pediatric Basic and Advanced Life Support
• Link to Key Acute Care Adult Medications section
• Link to Key Acute Care Pediatric Medications section
• Link to Primary and Secondary Survey

‡ Not FDA approved for this indication/Off-label use