nervgas antidote infos

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    * GENERAL INFORMATION: Administration of antidotes is a critical step in managing a patient/victim. However, this may be difficult to achieve in the Red Zone, because the antidotes may not be readily available, and procedures or policies for their administration in the Red Zone may be lacking. Do not administer antidotes preventatively; there is no benefit to doing so. Diazepam (or other benzodiazepines) should be administered when there is evidence of seizures, usually seen in cases of moderate to severe exposure to a nerve agent. Remember, physical findings of localized exposure often precede systemic exposure and physical findings.

    * ANTIDOTE: Atropine and pralidoxime chloride (2-PAM Cl) are antidotes for nerve agent toxicity; however, 2-PAM Cl must be administered within minutes to a few hours (depending on the agent) following exposure to be effective. There is also generally no benefit in giving more than three injections of 2-PAM Cl. Atropine should be administered every 5 to 10 minutes until secretions begin to dry up. If the military Mark I kits containing autoinjectors are available, they provide the best way to administer the antidotes to healthy adults. One autoinjector automatically delivers 2 mg atropine and the other automatically delivers 600 mg 2-PAM Cl. If the Mark I kit is unavailable, or the patient/victim is not an otherwise healthy adult, administer antidotes as described below:
      Infant (0 - 2 yrs), for mild to moderate physical findings, including localized sweating, muscular twitching (fasciculations), nausea, vomiting, weakness, and shortness of breath (dyspnea); administer Atropine at 0.05 mg/kg IM; 2-PAM Cl at 15 mg/kg IM.
      Infant (0 - 2 yrs), for severe physical findings, including unconsciousness, convulsions, cessation of breathing (apnea), and floppy (flaccid) paralysis; administer Atropine at 0.1 mg/kg IM; 2-PAM Cl at 25 mg/kg IM.
      Child (2 - 10 yrs), for mild to moderate physical findings, including localized sweating, muscular twitching (fasciculations), nausea, vomiting, weakness, and shortness of breath (dyspnea); administer Atropine at 1 mg/kg IM; 2-PAM Cl at 15 mg/kg IM.
      Child (2 - 10 yrs), for severe physical findings, including unconsciousness, convulsions, cessation of breathing (apnea), and floppy (flaccid) paralysis; administer Atropine at 2 mg/kg IM; 2-PAM Cl at 25 mg/kg IM.
      Adolescent (> 10 yrs), for mild to moderate physical findings, including localized sweating, muscular twitching (fasciculations), nausea, vomiting, weakness, and shortness of breath (dyspnea); administer Atropine at 2 mg/kg IM; 2-PAM Cl at 15 mg/kg IM.
      Adolescent (> 10 yrs), for severe physical findings, including unconsciousness, convulsions, cessation of breathing (apnea), and floppy (flaccid) paralysis; administer Atropine at 4 mg IM; 2-PAM Cl at 25 mg/kg IM.
      Adult, for mild to moderate physical findings, including localized sweating, muscular twitching (fasciculations), nausea, vomiting, weakness, and shortness of breath (dyspnea); administer Atropine at 2 to 4 mg IM; 2-PAM Cl at 600 mg IM.
      Adult, for severe physical findings, including unconsciousness, convulsions, cessation of breathing (apnea), and floppy (flaccid) paralysis; administer Atropine at 6 mg IM; 2-PAM Cl at 1800 mg IM.
      Elderly, frail for mild to moderate physical findings, including localized sweating, muscular twitching (fasciculations), nausea, vomiting, weakness, and shortness of breath (dyspnea); administer Atropine at 1 mg IM; 2-PAM Cl at 10 mg/kg IM.
      Elderly, frail for severe physical findings, including unconsciousness, convulsions, cessation of breathing (apnea), and floppy (flaccid) paralysis; administer Atropine at 2 to 4 mg IM; 2-PAM Cl at 25 mg/kg IM.
      Assisted ventilation should be started after administration of antidotes for severe exposures.
      Repeat atropine (2 mg IM for adults or 0.05 to 0.1 mg/kg for children) at 5 to 10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

    * EYE:
          o Immediately remove the patient/victim from the source of exposure.
          o Often the first physical finding of minimal symptomatic exposure to nerve agent vapor is markedly constricted pupils (miosis); however, if this is the only physical finding of nerve agent exposure, do not administer antidotes but follow the instructions below.
          o When exposed to liquid nerve agent, immediately flush the eyes with water for about 5 to 10 minutes by tilting the head to the side, pulling the eyelids apart with fingers, and pouring water slowly into the eyes.
          o When exposed to nerve agent vapor, there is no need to flush the eyes.
          o Do not cover eyes with bandages.
          o Changes in the eye can lead to nausea and vomiting without necessarily being a sign of systemic exposure. However, if eye pain, nausea, or vomiting are seen in combination with any other physical findings of nerve agent poisoning, administer antidotes atropine and 2-PAM Cl as directed.
          o Seek medical attention immediately.

    * INGESTION:
          o Immediately remove the patient/victim from the source of exposure.
          o Ensure that the patient/victim has an unobstructed airway.
          o Do not induce vomiting (emesis).
          o Administer nothing by mouth (NPO).
          o If the patient/victim's condition can be evaluated within 30 minutes of ingestion, in a hospital setting, consider gastric lavage. Gastric contents should be considered potentially hazardous and should be quickly isolated.
          o Be alert to physical findings of systemic exposure, and administer antidotes as required.
          o Maintain records of all injections given.
          o Seek medical attention immediately.

    * INHALATION:
          o Immediately remove the patient/victim from the source of exposure.
          o In cases of moderate to severe exposure, antidotes alone will not provide effective treatment, and ventilatory support is essential.
          o Evaluate respiratory function and pulse.
          o Ensure that the patient/victim has an unobstructed airway.
          o Assist with ventilation as required. Do not provide mouth-to-mouth resuscitation. Contact with off-gassed vapor or with liquid agent may occur.
          o If shortness of breath occurs, or breathing is difficult (dyspnea), administer oxygen.
          o Suction secretions from the nose, mouth, and respiratory tract.
          o Marked resistance to ventilation is expected due to bronchial constriction and spasm. Resistance lessens after administration of atropine.
          o Ventilatory distress is a physical finding of systemic exposure and requires antidote administration.
          o Maintain records of all injections given.
          o Seek medical attention immediately.

    * SKIN:
          o Immediately remove the patient/victim from the source of exposure.
          o Some nerve agents may remain in the hair or clothing and should be decontaminated, if that was not previously done. See the decontamination section of this card.
          o Skin exposure to liquid nerve agents will not necessarily result in systemic exposure if the site of exposure is decontaminated promptly. Before administering nerve agent antidotes, observe the site of exposure for localized sweating and muscular twitching. If these physical findings appear, administer antidotes; otherwise careful observation is all that is needed.
          o Maintain records of all injections given.
          o Seek medical attention immediately.