Chemical Terrorism for the Intensivist
The use of chemical agents for terrorist attacks or military warfare is a major concern at the presenttime. Chemical agents can cause signiﬁcant morbidity, are relatively inexpensive, and are easy to store and use.Weaponization of chemical agents is only limited by the physicochemical properties of some agents. Recent incidentsinvolving toxic industrial chemicals and chemical terrorist attacks indicate that critical care services are frequentlyutilized. For obvious reasons, the critical care literature on chemical terrorism is scarce. This article reviews the clinicalaspects of diagnosing and treating victims of chemical terrorism while emphasizing the critical care management. Theintensivist needs to be familiar with the chemical agents that could be used in a terrorist attack. The military classiﬁcation divides agents into lung agents, blood agents, vesicants, and nerve agents. Supportive critical care is the cornerstoneof treatment for most casualties, and dramatic recovery can occur in many cases. Speciﬁc antidotes are available forsome agents, but even without the antidote, aggressive intensive care support can lead to favorable outcome in manycases. Critical care and emergency services can be overwhelmed by a terrorist attack as many exposed but not ill willseek care.