The Medical Management of Biological Casualties

United States Army Medical Research Institute of Infectious Diseases (USAMRIID)

Symptoms (check all that apply)

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• Cardiovascular
• Neurological
• Ocular
• Pathogenicity
• Skin
• Respiratory
• Gastrointestinal
• Salivary
• Other

Normal heart rate

Slow heart rate (bradycardia)

Rapid heart rate (tachycardia)

Hypotension

Flushing of the face and/or chest

Convulsions and/or muscle twitching

Progressive, descending skeletal muscle flaccid paralysis

Headache

Loss of muscle control (ataxia)

Muscle aches (myalgias)

Eye pain, tearing, redness

Small pupils

Droopy eyelids, large pupils, disconjugate gaze

"red eyes" (conjunctival infection)

eye discomfort in bright light (photophobia)

Blurred vision

Unlikely to Cause Fatalities

Potentially Fatal within Minutes of Presentation

Potentially Fatal Days after Presentation

skin pain

itchy skin

a painless skin lesion

Ulcer with coal black scab

papular or pustular skin lesions

Severe neck swelling (often unilateral)

an abnormal accumulation of fluid beneath the skin

leathery blackening and sloughing of large areas of skin

Petechiae, a small red or purple spot caused by bleeding

bluish skin (cyanosis)

Difficult breathing, airway constriction

bloody nose (epistaxis)

Normal, then progressive paralysis

Nonproductive cough

Productive cough

Coughing up blood (hemoptysis)

Chest pain

Shortness of breath (dyspnea)

A high-pitched, noisy respiration (Stridor)

Rapid breathing (tachypnea)

Fluid on the lungs

Pneumonia symptoms

Nasal discharge

Increased motility, pain, diarrhea within minutes?

Decreased motility within 12 – 48 hours?

Nausea, vomiting and/or diarrhea

Severe pharyngitis, followed by oral ulcers which progress from

Difficulty swallowing (dysphagia)

Abdominal pain

Profuse, watery saliva within minutes?

Normal; difficulty swallowing (dysphagia) within 12 – 48 hours

May be slightly increased quantities of saliva within 1 – 6 ho

Symptoms are Responsive to Atropine

Low-grade fever

High-grade fever

Fever comes and goes

Malaise/Fatigue

Drenching sweats (diaphoresis)

Shock

Joint pain (arthralgias)

Depression and/or other mental status changes

Weight loss

Testicular pain

Lymphadenopathy

Cervical Lymphadenopathy

Back pain

Rigors (chills)

an abnormal propensity toward bleeding (bleeding diathesis)

an impairment in the ability to produce voice sounds

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