0071643192.pdf

EMS AND DISASTER MEDICINE^912

Nerve agents (sarin, soman,

VX) inhibit acetylcholinesterase

producing a cholinergic

toxidrome.

Antidotes to nerve agent

poisoning=atropine and

pralidoxime.

DIAGNOSIS

■ ELISA or PCR

TREATMENT

■ Supportive care

■ Antiviral: Ribavirin

■ Prophylaxis: Ribavirin

CHEMICAL WEAPONS OF MASS DESTRUCTION

Agents include nerve agents, vesicants, and blood agents (cyanide: see

Chapter 6.)

Nerve Agents

Nerve agents are organophosphates and include sarin, soman, VX.

PATHOPHYSIOLOGY

■ Inhibit acetylcholinesterase → accumulation of acetylcholine at mus-

carinic and nicotinic receptors →cholinergic toxidrome.

SYMPTOMS/EXAM

■ Cholinergic toxidrome (SLUDGE): Salivation/sweating, lacrimation, uri-

nation, defecation, GI distress, emesis

■ Miotic pupils

■ Fasciculations, muscle weakness, apnea

■ Altered mentation or seizures

DIAGNOSIS

■ Based on history of exposure and clinical presentation

TREATMENT

■ Supportive care

■ Atropinedosed to secretion control (may require 2–4 mg at frequent

intervals)

■ Pralidoximechloride (2-PAM) to reverse paralysis

■ Benzodiazepinesfor seizures

Vesicants

Agents that induce blistering via cellular damage, including mustard

SYMPTOMS/EXAM

■ Local skin effects: Severe pain, vesicle formation, and inflammation to site

of contact

■ Skin injury resembles second-degree burn.

■ Inhalation effects: Pharyngeal edema and pulmonary necrosis →varying

degrees of respiratory distress

■ Systemic effects: Bone marrow suppression