NERVE AGENT EXPOSURE CA128

OBJECTIVE Identify the specific signs and symptoms of nerve agent exposure CA129

HOW NERVE AGENTS WORK Attack nervous system nervous system controls body functions through use of chemicals which act as “instructions” to nerves, muscles and glands Nerve agents interfere with normal chemical instructions Nerve synapse CA130

NORMAL NERVOUS SYSTEM At nerve ending, acetylcholine is released Acetylcholine crosses synapse between nerve endings if junction with skeletal muscle, muscles cells contract if junction with smooth muscles, muscles move rhythmically if junction with gland, glandular cells secrete Acetylcholine is inactivated by acetylcholinesterase Normal activity at nerve synapse CA131

HOW NERVE AGENTS WORK Nerve agents block acetylcholinesterase so it cannot destroy acetylcholine acetylcholine accumulates and continue to stimulate target nerve muscles twitch uncontrollably and repetitively excess secretions of glands Nerve agent interferes with normal synapse activity CA132

ROUTES OF EXPOSURE Direct Contact Inhalation Ingestion CA133

INHALATION Nerve agents enter through respiratory system Rapidly and effectively enter into blood stream Respiratory failure chief cause of death after severe exposure Nerve agent inhaled into respiratory system CA134

DIRECT CONTACT Skin or eyes are touched with agent vapor or liquid Nerve agents absorbed through skin VX remains on skin and absorbed more completely GB evaporates quickly, but still a threat Scrapes, cuts or other skin damage offer direct entry points freshly shaven skin, sunburn, insect bites, rashes Eyes most sensitive organ for nerve agent vapor effects CA135

INGESTION Ingestion of contaminated food or drink, incidental hand to mouth or eye contact, smoking Unlikely that agent will contaminate food or drink Gastrointestinal system CA136

SIGNS AND SYMPTOMS Not all signs and symptoms may appear . . . Signs are objective evidence of a medical condition Signs are observed (runny nose, drooling) Symptoms are subjective evidence Symptoms are verbally communicated (headache, eye pain) Not all signs and symptoms may appear . . . Dose, duration, and route of exposure make a difference CA137

SIGNS AND SYMPTOMS OF NERVE AGENT EXPOSURE Miosis Dim or blurred vision Respiratory trouble Difficulty in breathing Increased oral/nasal secretions Localized sweating Nausea and vomiting Abdominal cramping Involuntary urination or bowel movements Heartbeat irregularities Generalized weakness Twitching or muscles spasms Convulsions and coma CA138

OTHER SIGNS AND SYMPTOMS OF NERVE AGENT EXPOSURE May result from early or mild exposure: headache anxiety restlessness giddiness irritability CA139

FACTORS AFFECTING NERVE AGENT SIGNS AND SYMPTOMS Signs and symptoms may appear immediately or be delayed Reaction time depends on type of agent amount of agent person has been exposed to dose (how much a person has absorbed) duration of exposure route of exposure sensitivity of person’s system CA140

FACTORS AFFECTING NERVE AGENT SIGNS AND SYMPTOMS Immediate if moderate to large amounts are inhaled if moderate to large amounts are spilled onto the skin Delayed if small amounts are involved if agent has been absorbed through skin in small localized area CA141

INHALATION PEAK EFFECTS FROM NERVE AGENT Effects can occur after single breath Immediate response within seconds Peak effects usually within 15 - 20 minutes After about 20 minutes, effects usually maximized and will not worsen Respiratory system CA142

DIRECT CONTACT PEAK EFFECTS FROM NERVE AGENT Absorption may continue for hours even after decontamination Effects may not occur for 1 to 18 hours effects usually not lethal CA143

OTHER POSSIBLE CAUSES Signs and symptoms may also be caused by epilepsy gastroenteritis exposure to agricultural insecticides emphysema strokes head trauma drug overdose heat illnesses allergies upper respiratory illnesses CA144

INITIAL FIRST AID TREATMENT Immediate removal from source of exposure severity directly proportional to absorbed dose Decontamination preferred decontamination solution is undiluted household bleach Antidote administration with airway management support as necessary Must be provided by properly trained and equipped personnel CA145

NERVE AGENT ANTIDOTE Atropine 2-PAM Chloride administered to block receptor sites of acetylcholine 2-PAM Chloride restores acetylcholinesterase Two-part nerve agent antidote CA146