There is no particular laboratory test for confirming phosgene exposure; nevertheless, many methods of monitoring pulmonary health should be used. A chest x-ray, oxygen saturation, ABG, and volume status evaluation are among them (initially via vital signs and examination of mucous membranes).
An X-ray of the chest often reveals pulmonary edema symptoms, with hilar enlargement as the first finding (4-8 hours after exposure) and ill-defined patchy infiltrates. Additional tests such as the following may be needed to distinguish between pulmonary edema and ARDS.
- Troponin T
- NT pro-BNP
Those exposed to large amounts should be monitored for 24 hours due to the likelihood of delayed pulmonary edema. The major criteria to be monitored are chest radiography, physical findings, and ABG.
Treatment is primarily supportive; no antidote for phosgene exposure is currently available. As with any poisoning, decontamination is critical; the patient must be removed from the contaminated surroundings and stripped of their clothes first.
If the skin or eyes have been exposed, they should be thoroughly rinsed with tepid water. A thorough rinse and wash with soap and water should be performed in locations with direct skin contact. Physical effort should be avoided after inhalation exposure, and rigorous bed rest should be imposed for 24 to 72 hours, especially if the exposure dosage was unknown or more than 25 ppm/min.