Presentation on theme: "Nerve agents & Mark 1 Auto injectors"— Presentation transcript:
1 Nerve agents & Mark 1 Auto injectors Harbor-UCLA Medical CenterSouth 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 destructionDiscuss the clinical presentation of a patient exposed to a nerve agentDemonstrate the use of a Mark 1 Nerve Antidote kit
3 Priorities in an “all hazards” response Life safetySafety of rescuersSafety of victimsAppropriate decontamination and treatment of victimsAppropriate protection for staff/rescuers and treatment if necessaryIncident coordination/stabilityProperty preservation-evidence collectionProtection of the environment
4 Initial treatment for nerve agent exposure Scene safetyImmediate removal of victim from source of exposureDirect proportional relationship between absorbed dose and severity of symptoms/morbidity & mortalityAirway management is keyAntidote administrationSeizures
5 Nerve agent triageWas Mark 1 given in the pre-hospital treatment? How many?Signs and symptoms upon presentationInitial symptoms improving?Is miosis still presentBronchorhhea present?
6 Minimal Treatment- Nerve agent exposure Patient exposed to nerve agentRecovering well from Mark 1 Kit admininstrationWalking and talking indicates respiratory and circulatory status is sufficient to maintain function
7 Expectant patients exposed to nerve agents Apneic for more than five minutesSeizures have already begunNo pulse or blood pressurePatient has minimal to no chance of survival no matter what treatmentPatient is declared expectant (black triage tag)
8 Signs and Symptoms: SLUDGE Over-stimulation of the nervous system causes muscles and certain glands to over-reactSalivationLacrimationUrinationDefecationGI DistressExcrement/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 symptomsCases we are familiar with in healthcare due to frequent exposuresMassive doses of AtropineCommon with gardeners in hot house environmentIndustrial plantsMigrant 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 cachesDosaging- Adult and PediatricAdministration of Mark 1 Kit
12 Mark 1 AutoinjectorsAtropine: administered to block receptor sites of acetylcholine2-PAM Chloride: restores acetylcholinesteraseCombo Pen/ Mark 1Package insert- review administration, side effects
13 Mark 1 Kits One chamber has 2mg of Atropine One chamber has 600 mg of 2 PamOther auto injectors contain Valium for seizure control
14 Atropine Dose Monitor Interval 2-Pam Dose Signs & SymptomsAtropine Dose Monitor Interval2-Pam DoseSevere Respiratory Distress, Agitation SLUDGE3 Auto-injectors (6 mg) Monitor every 5 minutes3 Auto-injectors (1.8 gms)Respiratory Distress, SLUDGE2 Auto-injectors (4 mg) Monitor every 10 minutes1 Auto-injector (600 mg)Asymptomatic NoneMonitor for signs & symptoms every 15 minutesNoneSource: New York Department of Health Policy Statement 03-05Use 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 disasterNotification to pharmacy that pharmaceutical caches are necessaryDelivery of medications to ERTreatment of staff/victimsPharmacy notifies CDC that CHEMPACK as been activated via Sensaphone
16 Thank you for your attention Please sign in on rosterPlease take three handoutsFor any further questions please notify Dr. Amy Kaji or KathyCrow
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