Page 96 - 2025 Ranger Medic Handbook

CBRN
MARCH SIGNS AND SYMPTOMS OF NERVE AGENTS
M – Massive hemorrhage/Mask check: always treat MUSCARINIC NICOTINIC
these situations as CUF. Apply TQs, patient’s mask, • Diarrhea • Mydriasis
• Urination
• Tachycardia
and move from danger area.
SECTION 2 A – Airway/Antidote: always ensure early and • Miosis • Weakness
• Hypertension
proper airway management with quick antidote
• Bronchorrhea/
• Fasciculations
administration
Bronchospasms
R – Respirations/Rapid DECON: positive pressure
• Bradycardia
ventilations and rapid spot DECON
C – Circulation/Counter measures: start IV/IO drips • Emesis
• Lacrimation
if needed • Salivation/Secretions/
H – Hypothermia/Head injury Sweating
PPE AND DECON CONSIDERATIONS
• Use of mask always required.
• Wearing a minimum of two (2) pairs of nitrile exam gloves will provide needed protection IOT put hands on
patient – as always ensure that you protect yourself first.
• Ensure patient is masked or has protected airway to prevent inhalation injuries
• When removing clothing and equipment ensure they are bagged and disposed of properly
• DECON with RSDL, to include wounds and eyes if needed, soap and water also works well with most CBRN
agents and precursors. DRY-WET-DRY for DECON.
• Place bleach in suction reservoir (if able) to ensure that body fluids are DECONed as well
NERVE AGENTS (G and V SERIES AGENTS)
MARCH PPE AND DECON CONSIDERATIONS
M – Massive hemorrhage/Mask check: ensure the • WEAR MASK.
patient has good mask seal • CBRN gloves needed IOT put hands on patient.
A – Airway/Antidote: ATNAA and CANAA • Ensure patient is masked or has protected airway to
R – Respirations/Rapid DECON: positive pressure prevent inhalation injuries
ventilations and rapid DECON with physical removal • DECON with RSDL, to include wounds and eyes if
of clothing and any liquids on skin needed. Soap and water also work well.
C – Circulation/Counter measures: atropine and
2-Pam drips
H – Hypothermia/Head injury
IMMEDIATE CONSIDERATIONS PFC CONSIDERATIONS
• Miosis is a highly variable sign of contamination • Atropine drip = Draw air from 250mL bag of saline
and does not dictate treatment and inject 50mL of 20/8 atropine. Mark bag with
• Suction will be needed for excess secretions “Atropine 300mL/20mg”. Set drip rate to 300mL/hr
• Patients with mild S/Sx should receive (or 1gtt/sec with 15gtt set line). Once atropinization
1 × ATNAA (self-aid) and 2 × ATNAA (buddy-aid) has been achieved reduce to 10–20% of original
• Patients with severe S/Sx should receive dose.
3 × ATNAA and 1 × CANA • 2-PAM 500mg bolus, a drip rate should be started
• BPT treat q3–5min with atropine auto injectors 30 minutes after original 1200mg dose (ATNAA) AND
• If no CANA, can treat with Versed 10mg IM for symptoms persist. Add 20mL/1g 2-PAM to 250mL
seizures bag of saline. Set drip rate to 270mL/hr
(or 1gtt/sec with 15gtt drop set).

82 SECTION 2 PRIMARY TRAUMA PROTOCOLS