Page 217 - 2022 Ranger Medic Handbook

Nerve Agent Tx: You have minutes to hours depending on what agent, where the animal absorbs it (inhaled vs ab-
sorbed) and how much was absorbed.
Antidote: Mild signs 1–2 ATNAA (2.1–4.2mg atropine and 600 to 1,200mg pralidoxime chloride), 1 CANA (10mg diaz-
epam), Severe signs (i.e., respiratory coughing and seizing) give 3–4 ATNAAs (6.3 – 8.4mg atropine and 1,800–2,400mg
pralidoxime chloride), 2 CANAs (20mg diazepam). Scopolamine at 0.03mg/kg (about 0.9mg for an MPC) PO q12–24hr
can be used as an alternative to atropine. Scopolamine acts as an antimuscarinic like atropine but may have better
CNS effects.
Decontaminate: 4% chlorhexidine and water (process described at the end of this section). Do not use RSDL, it may
react when bound with a chemical agent to bleach if bleach is used at the decontamination site. RSDL also only works
in short haired areas or the hairless areas of the abdomen of a dog.
Treat to ease of breathing or cessation of secretions (do not worry about fixing miosis or muscle fasciculation initially,
this response is usually delayed sometimes by months)!
Long-term: Atropine (0.4mg/mL) × 50mL in 250mL NaCl (20mg/300mL). Drip rate is 300mL/hr. When the pupils finally
begin to dilate and/or heart rate normalizes reduce drip rate to 30–60mL/hr and continue to monitor.
PREVENTION: No mask. Pyridostigmine bromide 0.5mg/kg (15mg) PO q8hr (half the human dose).
BZ Agent Signs: Almost the opposite of nerve agent. BZ agent will cause mydriasis (dilated pupils), dry mucus mem-
branes, tachycardia, hyperthermia, hypertension, warm skin, and seizures are possible.
BZ Agent Tx: Physostigmine at 0.025–0.5mg/kg (7–15mg) given slowly IV or IM. Do NOT sedate patient. Remove from
the exposure.
Decontaminate: Route of absorption is by inhalation only, removing from the source is all that is necessary.
Blister Agent Signs: Can be immediately painful (Lewisite) or delayed (Sulfur mustard). In dogs the hair stands up (pilo-
erection). Blisters do NOT occur. The skin becomes moist and hyperemic instead. Sloughing can occur later. Lewisite –
immediate pain, restlessness vomiting, bloody diarrhea, shock, weakness, anemia, pulmonary edema, blepharospasm
(squinting). HD and HN (Mustard) – asymptomatic latent period for a few hours then: Skin redness/ulcers, respiratory –
cough, nasal discharge, difficult breathing, tracheal and pulmonary rales (clicking), GI – oral ulceration, abdominal pain,
vomiting, bloody diarrhea, systemic – excitation, salivation, bradycardia, decreased WBC and platelet count, shock.
Blister Agent (Lewisite) Tx: Dimercaprol (BAL) 2.5–5mg/kg given IM q4hr for 2 days, topical BAL ointment as needed. SECTION 6
Use a chelating agent: 1) CaEDTA at 1% (10mg/mL) in 5% Dextrose at 27.5mg/kg q6hr for 2 to 5 days or 2) Sodium
Thiosulfate at 150mg/kg (4.5g). Adding 18mL of 25% (250mg/mL) Na Thiosulfate into 250mL of NaCl and bolus that
over 10min gives the patient 4.5g.
Blister Agent (Lewisite and Sulfur Mustard) Tx: Provide topical ocular analgesia, early intubation and use of ventilator/
PEEP and CPAP machine. Albuterol at 0.05mg/kg PO, antiemetic and antibiotics when secondary lung infections occur.
Control of bronchospasm may require more than just albuterol, if steroid is used be aware that secondary lung infection
risk is increased. Dexamethasone (0.025mg/kg q24 hours PO so about a 0.5mg – 1mg tablet) or prednisolone (1mg/kg
q12hr for up to a week PO then 0.5mg/kg for another week)
Decontaminate: RAPID Decon (within 2 minutes) is vital! 4% chlorhexidine (process described at the end of this sec-
tion). Do not use RSDL, it may react when bound with a chemical agent to bleach if bleach is used at the decontamina-
tion site. RSDL also only works in short haired areas or the hairless areas of the abdomen of a dog. Flush the eyes with
large amounts of water. Eye ointment for pain control only after thorough decon and examination. Steroid/antibiotic
combination eye ointment works best for saving the eye.
Cyanide Signs: Generally not used as a munition due to insufficient amounts delivered and the nature of the chemical.
Exposure more likely through ingestion poisoning or possibly by inhalation within enclosed spaces (tunnels/gas cham-
bers). Inhalation: effects begin within 15 seconds, death within 6–8 minutes of a lethal dose.
Ingestion: Upset stomach for 7 minutes followed by increased depth and rate of breathing. Within 15 minutes the
animal will likely lose consciousness. Convulsions/seizures, apnea, then the heart stops within 30 minutes. The loss of
consciousness and seizures shortly after inhalation is similar to nerve agent inhalation; however, the cyanide casualty is
not cyanotic (blue), pupil size is normal or dilated, and there are no secretions and no muscle fasciculation.

2022 RANGER MEDIC HANDBOOK 203