Page 82 - 2023 SMOG Digital

CBRN

INCAPACITATING AGENTS

Incapacitating Agents: PPE and Detection CRESS Symptomatic Presentation
Anticholinergics, Opioids, Riot • Mask (C2–A1 Filter) C: Varies with agents
Control • AP-PPE R:
• Variable; aerosol, smoke/gas, or • JLIST or UIPE E:
liquid S:
• Fentanyl derivatives extremely M8 Detection Paper S:
potent lethality • Not effective C C – Sedation OPI IOIDS
HOT ZONE POI Immediate Action + M 2 A 2 R 2 E. R – Decreased respirations

• address MASSIVE HEMORRHAGE / Mask check
E - miosis
• assess AIRWAY/administer ANTIDOTE
S – normal
• asses RESPIRATIONS/conduct RAPID SPOT DECON
S- normal
• Extract (move upwind, uphill, upstream–away from
OPIOID ANTIDOTE:
threat)
• NALOXXONE (2––4mg) additional escalating
L
doses up to10mg prn
• May require NAL LOXXONE drip at 2/3 of response
dose/hr
M 2 A 2 R 2 Reassessment • Support respirations as needed see
• Clear airway (copious secretions) RESPIRATORY DISTRESS
• Anticipate laryngospasms C C – Delirium, agitation
WARM ZONE DIRTY CCP not be sufficient, ARDS technique, need to manipulate R – – normal, tachypnea, tachycardia
• Place advanced airway (largest bore ET as able), be
ANTICHOLINERGICS
prepare to conduct cricothyroidotomy for failed airway

• Advanced Ventilatory support (SAVe or simple vent may
E – – red
peep, volume, FiO 2 )
S – – mydriasis
• O2 as needed, maintain air filter
S – red, hot dry
–
Decontaminate and Cutout
ANTICHOLINERGICS ANTIDOTE:
• Remove and bag equipment, PPE, and clothing
• Titrate Benzodiazepines (2– –4mg IV/IO/IM) to
• Soap and water sufficient for skin decon
• Remove and replace contaminated treatments (chest
• Support respirations as needed see
seals, tourniquets, etc.)
RESPIRATORY DISTRESS
2
2
C H E control severe agitation
Laryngospasm may occur with both Phosgene and
• CIRCULATION (asses vitals) COUNTERMEASURES
• Prevent HYPOTHERMIA/assess mental status (altered Chlorine. Anticipate airway edema and manage
due to agent or trauma?) HEAD INJURY airway early. If advanced airway required, place
• EVACUATE to next role of care/zone largest endotracheal tube possible to facilitate
suctioning. Intravenous fluids may be necessary in
the setting of volume depletion, but should not be
MARCHE 2 Reassessment given empirically. Fluid overload can contribute to
COLD ZONE • continue CIRCULATION support (monitor vitals), Consider following for wheezing
• Continue to address any immediate life threats
pulmonary edema and should be avoided.
• provide AIRWAY and RESPIRATORY support as
necessary, provide supplemental O2 even with normal
/bronchospasms:
SpO2
• ALBUTEROL (2.5mg in 3mL L NS)
CBRN
• METHYL LPREDNISOLONE (125mg IV)
resuscitate as necessary / COUNTERMEASURES 2 nd
• See RESPIRATORY DISTRESS
dose as appropriate)
• prevent HYPOTHERMIA with HPMK, warm fluids/HEAD
Mechanical Ventilations
INJURY treat elevated ICP, conduct neuro exam, MACE
• Use ARDS VENTILATOR MANAGEMENT
techniques
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