When multiple patients present with acute onset of difficulty breathing, chest tightness, and hoarseness or stridor, you should be most suspicious of exposure to which of the following?

When multiple patients present with acute onset of difficulty breathing, chest tightness, and hoarseness or stridor, you should be most suspicious of exposure to which of the following?

• A. Mustard gas
• B. Hydrogen cyanide
• C. Phosgene or chlorine
• D. Sarin

Answer: (C)

Acute airway irritation from inhaled pulmonary irritant gases best explains these symptoms. Chlorine and phosgene irritate the respiratory mucosa, causing immediate or rapidly worsening coughing, throat irritation, chest tightness, and airway edema that can lead to hoarseness or stridor as the airway narrows. Phosgene can have a delayed component as it damages further down the respiratory tract, but the combination of dyspnea with voice changes points to an irritant inhalation injury. Mustard gas is a vesicant with effects that typically appear later, not immediately as stridor or acute airway compromise. Hydrogen cyanide causes rapid systemic toxicity—hypoxia, headache, confusion—with less emphasis on upper airway irritation and stridor. Sarin, a nerve agent, produces a cholinergic surge with sweating, pinpoint pupils, secretions, and seizures—not primarily an airway-landing pattern like stridor early on. So, exposure to chlorine or phosgene best fits the clinical picture of acute airway involvement after inhalation.

Acute airway irritation from inhaled pulmonary irritant gases best explains these symptoms. Chlorine and phosgene irritate the respiratory mucosa, causing immediate or rapidly worsening coughing, throat irritation, chest tightness, and airway edema that can lead to hoarseness or stridor as the airway narrows. Phosgene can have a delayed component as it damages further down the respiratory tract, but the combination of dyspnea with voice changes points to an irritant inhalation injury.

Mustard gas is a vesicant with effects that typically appear later, not immediately as stridor or acute airway compromise. Hydrogen cyanide causes rapid systemic toxicity—hypoxia, headache, confusion—with less emphasis on upper airway irritation and stridor. Sarin, a nerve agent, produces a cholinergic surge with sweating, pinpoint pupils, secretions, and seizures—not primarily an airway-landing pattern like stridor early on.

So, exposure to chlorine or phosgene best fits the clinical picture of acute airway involvement after inhalation.