Page 202 - ATP-P 11th Ed

CBRN: NERVE AGENT POISONING PROTOCOL

SPECIAL CONSIDERATIONS
1. Vapor inhalation is typically more severe than liquid cutaneous exposure.
2. Medic must ensure scene safety, if in the area of exposure, leave!
3. Remove all patient clothing and decontaminate with a total body soap and water
scrub.
SECTION 2 4. Identification of specific agent is unnecessary. DO NOT DELAY THERAPY!
5. Atropine treats only muscarinic symptoms. Pralidoxime is needed to treat nico-
tinic symptoms.
6. Pralidoxime reactivates acetylcholinesterase; however, it is only useful if given
before agent ages.
7. If agent “ages” on acetylcholinesterase, it will be bound permanently.
8. Each nerve agent ages at a different rate (from 2 minutes to days).
9. Common reasons for exposure: insecticides, agricultural professions, and
weaponized.

Signs and Symptoms
1. Muscarinic = DUMBELS
D – Diarrhea
U – Urination
M – Miosis (pinpoint pupils)
B – Bronchospasm, bronchorrhea, bradycardia
E – Emesis
L – Lacrimation
S – Salivation, secretions, sweating
2. Nicotinic = MTWHF
M – Mydriasis (dilated pupils)
T – Tachycardia
W –Weakness
H – Hypertension
F – Fasiculations (involuntary twitches)
Triage Categories (single/few patients)
Category I
a. Miosis
b. Rhinorrhea
c. Salivation

192 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 193