Page 78 - 2023 SMOG Digital

CBRN

NERVE AGENT

Nerve Agent PPE and Detection CRESS Symptomatic Presentation
• Liquid or Vapor • Mask C: altered, unconscious, seizures
• Non-Persistent (GA, GB, GF) • AP–PPE R: tachypnea, wheezing, respiratory distress
• Persistent (VX) • JLIST or E: miosis (may or may not be present with
• Organophosphate Treatment UIPE organophosphate)
M8 Detection Paper S: copious secretions (salivation, lacrimation
• G–Yellow bronchorrhea)
• V–Green S: diaphoresis NERVE AGENT ANTIDOTE
HOT ZONE POI Immediate Action + M 2 A 2 R 2 E. Antidote Treatment, Nerve Agent, Auto-Injector
(ATNAA)
• ATNAA contains 2.1mg Atropine and 600mg
• address MASSIVE HEMORRHAGE / Mask check
Pralidoxime Chloride (2PAM) in each Auto
l
o
• assess AIRWAY / administer ANTIDOTE
Injector
• Initial administration is 3x ATNAA in rapid
• asses RESPIRATIONS / conduct RAPID SPOT DECON
sequence for sever signs of nerve agent
• Extract (move upwind, uphill, upstream – away from
poisoning (6.3mg Atropine, 1800mg 2PAM)
threat)
Convulsant Antidote Nerve Agent (CANA)
• CANA contains 10mg Diazepam
• Administer 1x CANA following 3x ATNAA
NERVE AGENT COUNTERMEASURES
WARM ZONE DIRTY CCP needed, filtered air) mins to dry secretions
ATROPINE IV/IO
s
s
M 2 A 2 R 2 Reassessment (clear airway, O 2 as
• 20mg in 250mL NS IV/IO, titrate 1mg every 3
• Decontaminate and Cutout
• Once clinical improvement achieved, adjust to
2
C H E
rate of 2–4mg/hr
2
• CIRCULATION (asses vitals, resuscitate) administer
PRALIDOXIME IV/IO
• 1–2g in 250mL NS IV/IO over 15-30min
COUNTERMEASURES as necessary if ATNAA/CANA
administered and symptoms persist
BENZODIAZEPINES IV/IO
• MIDAZOLAM (preferred)1–2mg IV/IO, titrate to
• Prevent HYPOTHERMIA / assess mental status (altered
due to agent or trauma?) HEAD INJURY
effect
• DIAZEPAM 10–20mg IV/IO, titrate to effect
• EVACUATE to next role of care/zone
SCOPOLAMINE IV/IM (adjunct if available)
• 0.8mg IV/IM
COLD ZONE • Continue to address any immediate life threats
MARCHE 2 Reassessment
• provide AIRWAY and RESPIRATORY support as
necessary
• continue CIRCULATION support /
COUNTERMEASURES as symptoms dictate
• prevent HYPOTHERMIA with HPMK, warm fluids /
HEAD INJURY treat elevated ICP, conduct neuro exam,
CBRN
MACE
Reassess regularly, follow protocols for respiratory or
cardiac compromise.
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