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Nerve Agents
Nerve agents inhibit CNS function and are highly lethal. Common nerve agents include GA (tabun), GB
(sarin), GD (soman), GF and VX. Use of pyridostigmine as a preventive measure for GA and GD is a
command decision.
Subjective: Symptoms
Eyes, nose and throat: Eye pain, dim vision, photophobia, nasal congestion, hoarseness.
Respiratory: SOB, tightness of chest, dyspnea
GI: Nausea, anorexia, epigastric tightness, heartburn, abdominal cramping
CNS: Apprehension, giddiness, insomnia, headache, drowsiness, difficulty concentrating, confusion, poor
memory, weakness
Objective: Signs
Using Basic Tools:
Eyes, nose and throat: miosis (pupillary contraction), lacrimation, conjunctivitis, rhinorrhea, nasal hyperemia
Respiratory: Tachypnea, wheezing, increased bronchial secretions, cough, Cheyne-Stokes respirations (5-30
seconds of apnea)
Cardiac: Occasional early tachycardia followed by bradycardia and hypotension
GI: Salivation, vomiting, diarrhea, involuntary defecation, extreme urgency
GU: Frequent urination, incontinence
CNS: Coma, seizures, ataxia, areflexia
Other: Muscle fasciculation, sweating, pallor, cyanosis
Assessment: Diagnosis based on clinical signs and symptoms, environment and probability.
Plan:
Treatment
Mask self, mask patient and inject atropine as follows:
Mild Exposure (miosis, headache, rhinorrhea, salivation, dyspnea): 1 Mark 1 auto-injector IM
Severe Exposure (all of the above plus SOB, apnea, generalized twitching, convulsions, urinary and stool
incontinence and paralysis): 3 Mark 1 auto-injectors IM and diazepam IM by auto-injector or 10 IM/IV if by
Carpuject (use of more than 1 Mark 1 increases the risk of heat illness)
Evacuation Plan: Evacuate if unstable after decontamination.
Blood Agents
High concentrations of blood agents such as cyanide exert their effect rapidly, causing unconsciousness and
death in a matter of minutes. However, if the patient is still alive after the cloud has passed (more than 5
minutes after presumed exposure), he will probably recover spontaneously.
Subjective: Symptoms
Eye and skin irritation. Low levels can cause weakness, headache, disorientation and nausea.
Objective: Signs
Using Basic Tools: Violent convulsions; increased deep respirations followed by cessation of respiration
within one minute; slowing of the heart rate until death.
Assessment: Diagnosis based on clinical signs and symptoms, environment and probability
Plan:
Treatment
Mask self and mask patient. Advanced Cardiac Life Support (ACLS) medications are usually not available in
the field, so it is useless to initiate ACLS without them.
Replace C 2 canisters on the protective mask after initial exposure.