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Nerve agents & Mark 1 Auto injectors Harbor-UCLA Medical Center South Bay Disaster Resource Center.

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Presentation on theme: "Nerve agents & Mark 1 Auto injectors Harbor-UCLA Medical Center South Bay Disaster Resource Center."— Presentation transcript:

1 Nerve agents & Mark 1 Auto injectors Harbor-UCLA Medical Center South Bay Disaster Resource Center

2 Objectives At the end of this in-service participants will be able to: Describe potential chemical agents used as weapons of mass destruction Discuss the clinical presentation of a patient exposed to a nerve agent Demonstrate the use of a Mark 1 Nerve Antidote kit

3 Priorities in an all hazards response Life safety Safety of rescuers Safety of victims Appropriate decontamination and treatment of victims Appropriate protection for staff/rescuers and treatment if necessary Incident coordination/stability Property preservation-evidence collection Protection of the environment

4 Initial treatment for nerve agent exposure Scene safety Immediate removal of victim from source of exposure Direct proportional relationship between absorbed dose and severity of symptoms/morbidity & mortality Airway management is key Antidote administration Seizures

5 Nerve agent triage Was Mark 1 given in the pre-hospital treatment? How many? Signs and symptoms upon presentation Initial symptoms improving? Is miosis still present Bronchorhhea present?

6 Minimal Treatment- Nerve agent exposure Patient exposed to nerve agent Recovering well from Mark 1 Kit admininstration Walking and talking indicates respiratory and circulatory status is sufficient to maintain function

7 Expectant patients exposed to nerve agents Apneic for more than five minutes Seizures have already begun No pulse or blood pressure Patient has minimal to no chance of survival no matter what treatment Patient is declared expectant (black triage tag)

8 Signs and Symptoms: SLUDGE Over-stimulation of the nervous system causes muscles and certain glands to over-react Salivation Lacrimation Urination Defecation GI Distress Excrement/Emesis

9 Effects of nerve agent on victim The nervous system controls body functions by secreting chemical transmitters which act as "instructions" to nerves, muscles and glands. Nerve agent exposure -interferes with the normal instructions of chemical transmitters that direct the muscle or gland to return to an un- stimulated, relaxed state. Action of toxic nerve agents is to over-stimulate the nerve endings and central nervous system.

10 Organophosphate poisonings SLUDGE symptoms Cases we are familiar with in healthcare due to frequent exposures Massive doses of Atropine Common with gardeners in hot house environment Industrial plants Migrant farm workers exposed to Malephyon

11 Nerve agent antidote History of the Mark 1 Kit auto injectors Placement of Mark 1 Kits in CHEMPACK and pharmaceutical caches Dosaging- Adult and Pediatric Administration of Mark 1 Kit

12 Mark 1 Autoinjectors Atropine: administered to block receptor sites of acetylcholine 2-PAM Chloride: restores acetylcholinesterase Combo Pen/ Mark 1 Package insert- review administration, side effects

13 Mark 1 Kits One chamber has 2mg of Atropine One chamber has 600 mg of 2 Pam Other auto injectors contain Valium for seizure control

14 Signs & Symptoms Atropine Dose Monitor Interval 2-Pam Dose Severe Respiratory Distress, Agitation SLUDGE 3 Auto-injectors (6 mg) Monitor every 5 minutes 3 Auto-injectors (1.8 gms) Respiratory Distress, SLUDGE 2 Auto-injectors (4 mg) Monitor every 10 minutes 1 Auto-injector (600 mg) Asymptomatic None Monitor for signs & symptoms every 15 minutes None Source: New York Department of Health Policy Statement Use of "Mark I Kits" (AtroPen Auto-Injector & Pralidoxime Chloride Injector)

15 How to obtain the Mark 1 Kits at Harbor-UCLA Medical Center Attending physician of ER declares a Code Triage- overhead page for disaster Notification to pharmacy that pharmaceutical caches are necessary Delivery of medications to ER Treatment of staff/victims Pharmacy notifies CDC that CHEMPACK as been activated via Sensaphone

16 Thank you for your attention Please sign in on roster Please take three handouts For any further questions please notify Dr. Amy Kaji or KathyCrow

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