Presentation is loading. Please wait.

Presentation is loading. Please wait.

DPT 8.1 Emergency Management of Nerve Agent Casualties.

Similar presentations


Presentation on theme: "DPT 8.1 Emergency Management of Nerve Agent Casualties."— Presentation transcript:

1 DPT 8.1 Emergency Management of Nerve Agent Casualties

2 DPT 8.1 Hospital Provider Management of Chemical Agent Casualties

3 DPT 8.1 EMS Management of Chemical Agent Casualties

4 DPT 8.1 Objectives Describe physiological actions of nerve agents Recognize signs and symptoms of nerve agent exposure Describe emergency management of nerve agent victims

5 DPT 8.1 Nerve Agents Tabun (GA), Sarin (GB), Soman (GD), VX Most toxic of the chemical agents Penetrate skin, eyes, lungs Loss of consciousness, seizures, apnea, death after large amount Diagnosis made clinically; confirmed in laboratory (cholinesterase)

6 DPT 8.1 Normal Nerve Function ACh

7 DPT 8.1 Normal Nerve Function ACh

8 DPT 8.1 Normal Nerve Function ACh AChE

9 DPT 8.1 How Nerve Agents Work AChE ACh GB

10 DPT 8.1 Effects of Nerve Agents Muscarinic – Smooth muscles – Exocrine glands – Cranial nerves (vagus) Nicotinic – Skeletal muscles – Ganglia Two types of cholinergic receptors:

11 DPT 8.1 SLUDGE-M S S alivation L L acrimation U U rination D D efecation G G I upset – nausea/vomiting, cramps, diarrhea E E mesis M M uscle twitching Signs and Symptoms of Nerve Agents Mnemonic

12 DPT 8.1 DUMBELS D D iarrhea U U rination M M iosis B B radycardia, Bronchorrhea, Bronchospasm E E mesis L L acrimation S S alivation, Sweating Signs and Symptoms of Nerve Agents Newer Mnemonic

13 DPT 8.1 Signs and Symptoms of Nerve Agents Muscarinic Sites Increased secretions – Saliva – Tears – Runny nose – Secretions in airways – Secretions in gastrointestinal tract – Sweating

14 DPT 8.1 Signs and Symptoms of Nerve Agents Muscarinic Sites Smooth muscle contraction – Eyes: miosis – Airways: bronchoconstriction (shortness of breath) – Gastrointestinal: hyperactivity (nausea, vomiting, and diarrhea)

15 DPT 8.1 Signs and Symptoms of Nerve Agents Nicotinic Sites Skeletal muscles – Fasciculations – Twitching – Weakness – Flaccid paralysis Other (ganglionic) – Tachycardia – Hypertension GB ACh

16 DPT 8.1 Nerve Agents Other Signs and Symptoms Cardiovascular – Tachycardia, bradycardia – Heart block, ventricular arrhythmias Central Nervous System – Acute Loss of consciousness Seizures Apnea – Prolonged (4-6 weeks) Psychological effects

17 DPT 8.1 Signs and Symptoms of Nerve Agents Vapor Exposure Mild exposure – Miosis (dim vision, eye pain), rhinorrhea, dyspnea Moderate exposure – Pronounced dyspnea, nausea, vomiting, diarrhea, weakness Severe exposure – Immediate loss of consciousness, seizures, apnea, and flaccid paralysis Vapor effects occur within seconds, peak within minutes; no late onset

18 DPT 8.1 Signs and Symptoms of Nerve Agents Liquid Exposure Mild exposure (to 18 hours) – Localized sweating – Fasciculations – No miosis Moderate exposure (

19 DPT 8.1 Diagnosis of Nerve Agent Exposure Symptomatic – May be systemic or organ-specific – Combination of symptoms is more definitive Situational – Multiple casualties with similar symptoms – Time or location factors in common

20 DPT 8.1 Nerve Agents Treatment Removal from exposure Decontamination Airway/ventilation – High resistance Antidotes – Atropine – 2-PAMCl – Diazepam

21 DPT 8.1 Nerve Agents Treatment Atropine – Antagonizes muscarinic effects – Dries secretions; relaxes smooth muscles – Given IV, IM, ET No effect on pupils No effect on skeletal muscles IV in hypoxic patient Ù ventricular fibrillation

22 DPT 8.1 Nerve Agents Treatment Starting dose - 2 mg Maximum cumulative dose - 20 mg – Total dose calculated over time; but enough must be administered to abate severe symptoms if casualty is to survive – Insecticide poisoning requires much more Side effects in normal people – Mydriasis – Blurred vision – Tachycardia – Decreased secretions and sweating

23 DPT 8.1 Nerve Agents Treatment Atropine - How much to give? – Until secretions are drying or dry – Until ventilation is easy If conscious or casualty is comfortable – Do not rely on heart rate/pupil size

24 DPT 8.1 Nerve Agents Treatment Pralidoxime Chloride (2-PAMCl) – Remove nerve agent from AChE in absence of aging – 1 gram slowly (20-30 minutes) in IV infusion Hypertension with rapid infusion – No effects at muscarinic sites – Helps at nicotinic sites AChE 2-PAMCl Nerve Agent

25 DPT 8.1 Nerve Agents Treatment - Autoinjectors

26 DPT 8.1 MARK I Injection IM vs. IV

27 DPT 8.1 MARK I Injections Dispersal

28 DPT 8.1 Nerve Agents Treatment Diazepam – Decreases seizure activity – Reduces seizure-induced brain injury – Give to severely intoxicated casualties whether convulsing or not

29 DPT 8.1 Nerve Agents Treatment No signs/symptoms Reassure Observe – Vapor: 1 hour – Liquid: Up to 18 hours

30 DPT 8.1 Nerve Agents Treatment Mild vapor exposure – Miosis, rhinorrhea - observation only – Increasing SOB – treat Mild liquid exposure – Localized fasiculations & sweating - treat One MARK I kit (2 mg atropine/ 600 mg 2-PAMCl) OR 1 gram 2-PAMCl IV 2 mg atropine, IM or IV Parenteral atropine will not reverse miosis Treat with:

31 DPT 8.1 Nerve Agents Treatment Moderate vapor or liquid exposure – More severe respiratory distress – Muscular weakness – Nausea, vomiting, and diarrhea – One or two MARK I kits OR – IV: 2 to 4 mg atropine 1gm 2-PAMCl (infusion) Treat with:

32 DPT 8.1 Nerve Agents Treatment Severe vapor or liquid exposure – Unconscious – Seizing or post-ictal – Apneic or severe dyspnea – Twitching or flaccid – Effects in 2 or more body system – 3 MARK I kits OR – 6 mg atropine IV and 1 gram of 2-PAMCl IV – Airway – Ventilation/O 2 – Consider diazepam 10 mg IM (2 to 5 mg IV) – Repeat atropine every 5 to 10 minutes as needed – Repeat 2-PAMCl in one hour

33 DPT 8.1 Nerve Agents Age-Related Treatment Atropine – Infant (0 to 2)0.5 mg IM – Child (2 to 10) 1.0 mg IM – Adolescent (> 10)2.0 mg IM – Elderly1.0 mg IM – IV for infants and children0.02 mg/kg

34 DPT 8.1 Nerve Agents Age-Related Treatment 2-PAMCl – < 20 kg15 mg/kg IV – > 20 kg600-mg IM autoinjector – Elderly1/2 adult dose (7.5 mg/kg IV) 2-PAMCl-induced hypertension – PhentolamineAdult - 5 mg IV Child- 1 mg IV

35 DPT 8.1 Nerve Agents Age-Related Treatment Diazepam - Infants > 30 days old mg/kg IV to 5 yearsq 2 to 5 min (max 5 mg) - Children > 5 years 1 mg IV q 2 to 5 min (max 10 mg)

36 DPT 8.1 Nerve Agents Summary Vapor exposure – Symptoms develop suddenly – Most ambulatory victims require minimal intervention – Risk of secondary contamination, which is minimized by removing the victims clothing – Requires immediate access to antidotes Liquid exposure –Symptoms delayed minutes to hours –Greater need for decontamination –High risk of secondary contamination; victims require decontamination (clothing removal & washdown) –Requires immediate access to antidotes

37 DPT 8.1 DOMESTICPREPAREDNESS TRAINING TEAM HELPLINE: (800) FAX: (410) U.S. ARMY SBCCOM ATTN: AMSSB-RDP 5183 BLACKHAWK ROAD ABERDEEN PROVING GROUND MARYLAND Reference


Download ppt "DPT 8.1 Emergency Management of Nerve Agent Casualties."

Similar presentations


Ads by Google