WMD Nerve Agent

 

History:

 

  • Exposure to chemical/biological/ radiological/nuclear hazard
  • Potential exposure to unknown substance/hazard

 

Significant Findings:

 

  • Visual disturbances
  • Headache
  • Nausea/vomiting
  • Salivation
  • Lacrimation
  • Respiratory distress
  • Diaphoresis
  • Seizure activity
  • Respiratory arrest

 

Differential:

 

  • Nerve agent exposure (e.g., VX, sarin, soman, etc.)
  • Organophosphate exposure (pesticide)
  • Vesicant exposure (e.g., mustard gas, etc.)
  • Respiratory irritant exposure (e.g., hydrogen sulfide, ammonia, chlorine, etc.)

 

Treatment:

 

 

 

  • Oxygen
  • Initiate triage and/or decontamination as indicated; avoid inhalation and skin contact

 

 

 

  • Initiate IV

 

 

 

  • 12-Lead EKG
  • Obtain BGL

 

Minor Symptoms:

 

  • Salivation
  • Lacrimation
  • Visual disturbances

 

 

 

  • Atropine 2 mg IV/IM every 5 min until symptoms resolve

 

Major Symptoms:

 

  • Altered mental status
  • Seizures
  • Respiratory distress

 

 

 

  • Nerve agent kit IM x 3 rapidly (see pediatric doses below)

 

  • if unconscious, seizing and/or fasciculating:

 

 

 

 

  • Atropine 2 mg IV/IM every 5 min until symptoms resolve

 

  • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • In the face of a bona fide attack, begin with 1 nerve agent kit for patients less than 7 years of age, 2 nerve agent kits from 8 to 14 years of age, and 3 nerve agent kits for patients 15 years of age and over.
  • If triage/MCI issues exhaust supply of nerve agent kits, use pediatric atropens (if available). Use the 0.5 mg dose if patient is less than 40 pounds (18 kg), 1 mg dose if patient weighs between 40 to 90 pounds (18 to 40 kg), and 2 mg dose for patients greater than 90 pounds (greater than 40 kg).
  • Follow local HAZMAT protocols for decontamination and use of personal protective equipment.
  • Carefully evaluate patients to ensure they are not reacting from exposure to another agent (e.g. narcotics, vesicants, etc.).
  • All supervisors carry nerve agent kits which contains 600 mg of Pralidoxime (Protopam) and 2 mg of Atropine.
  • The main symptom that the Atropine addresses is excessive secretions so Atropine should be given until salivation improves.

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic