Page 77 - 2023 SMOG Digital

CBRN

RAPID IDENTIFICATION OF
CHEMICAL-WARFARE AGENTS

Assess: Observations:
C- Consciousness • unconscious, seizures, depressed consciousness, agitation
R- Respirations • present, absent, labored, increased, decreased, normal, abnormal
E- Eyes • constricted, dilated, normal
S- Secretions • dry, normal, increased
S- Skin • diaphoretic, dry, hot, cyanosis
Can conventional mechanisms of injury alone account for YES Treat as conventional Mass-Casualty incident:
observed effects, signs and symptoms? • Remain vigilant for CBRN signs and symptoms
(CRESS)
NO
Consider CBRN. Assume Nerve Agent
• Don personnel PPE • NERVE AGENT
• Assess casualty CRESS • Atropine and Pralidoxime
Any increase in:
SECRETIONS (lacrimation, rhinorrhea, salivations, bronchial secretions) YES Consider Asphyxiant
Muscle Effects (fasciculation, weakness, paralysis) • BLOOD AGENT
With or without constricted pupils (miosis) • Administer Cyanide Antidote
NO
Consider Opioid Agent
NO Bradypnea or apnea? YES Gasping, collapse, and seizures YES • INCAPACITATING AGENTS
with or without cyanosis?
Unlikely to be CBRN NO Miosis? YES • Administer Naloxone
• Reassess for conventional Sedation? YES Consider Anesthetic Agent
injuries NO • INCAPACITATING AGENTS
• Monitor for delayed CBRN NO • Manage airway as needed
effects • If unsure, administer Naloxone
Mydriasis, dry skin, YES
Confusion? YES elevated temperature? Consider Anticholinergic Agent
• INCAPACITATING AGENTS
NO • Manage airway as needed
YES YES YES
Respiratory noise? Eye, throat, or Consider Vesicant/Blister Agent
(coughing, hoarseness, stridor) skin pain? Skin Blistering? • VESICANT BLISTER AGENTS
Or
NO NO NO Consider Riot Control Agent
• INCAPACITATING AGENTS
Delayed onset shortness of breath YES
or chest tightness? Consider Pulmonary Agent
(Central Compartment, large airway)
NO • PULMONARY AGENTS CBRN
Consider Pulmonary Agent
NO Diplopia, descending YES (peripheral compartment, small
paralysis, dysphagia, and airway)
mydriasis? Consider botulinum toxin • PULMONARY AGENTS

Pearls:
• Treatment goals of CBRN is give anti-dote, provide airway support, conduct spot decontamination.

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