Page 216 - PJ MED OPS Handbook 8th Ed

Dirty CCP as able:
• Circulation, Administer Countermeasures
• Hypothermia, Head Wound
• Extraction, Evacuation

NOTE: CBRN Casualties take twice as long to treat as conventional wartime casualties. Rea-
sons for this are the added complexity of working in PPE and the complexity of CBRN Trauma
and Poisoning.
Limiting exposure and the catastrophic impacts of hypothermia will be some of the medic’s
biggest hurdles.

Care of Chemical Agent Injuries
There are five major types of chemical agents:
1. Nerve Agents
2. Vesicants
3. Cyanide
4. Pulmonary agents
5. Riot control agents

Nerve agents:
The signs and symptoms of nerve agent poisoning will depend on the dose and route of the ex-
posure. In general, larger doses and direct inhalation of nerve agent vapor result in quicker onset
and greater severity of effects. The most important effects of nerve agents are on the lungs, airway
and the nervous system. Nerve agents exert their toxic effects by inhibiting or blocking the action
of acetylcholinesterase (AChE), a critical enzyme. AChE is found in the plasma, red blood cells and
nervous tissue. Although nerve agents will affect the enzyme in all three areas, it is the neurological
effects which are the most important.
The mnemonic SLUDGE helps identify some of these findings:
• Salivation
• Lacrimation
• Urination
• Defecation
• Gastric
• Emptying

Key Measures in Resuscitating Nerve Agent Patients
• Secure the airway and provide positive pressure ventilation
• Administer atropine and 2-Pam-Chloride
• Administer Valium if supplied. Otherwise utilize Versed
• Repeat atropine as needed

214 n Pararescue Medical Operations Handbook / 8th Edition