PREVENTION AND TREATMENT OF NERVE AGENT POISONING

The essential prevention and treatment of nerve agent poisoning include the following actions:

Donning the protective mask and hood at the first indication of a nerve agent attack.

Administering atropine and pralidoxime chloride (2 PAM Cl) as soon as any symptoms are noted.

Administering convulsant antidote for nerve agents (CANA) to moderately or to severely poisoned casualties. CANA is also referred to as diazepam.

Removing or neutralizing any liquid contamination immediately.

Removing airway secretions if they are obstructing the airway. Airway suction may be needed.

Establishing a patient airway (for example, with a cricothyroidotomy or endotracheal tube) and administering assisted ventilation, if required. Only qualified personnel can perform these procedures. You should use oxygen if available.

NERVE AGENT ANTIDOTES

Atropine sulfate and 2 PAM Cl remain essential drugs in the treatment of nerve agent poisoning. When exposed, each member of the Navy and Marine Corps is issued three 2 mg auto injectors of atropine and three 600 mg auto injectors of 2 PAM Cl (fig. 13-30). Do not give nerve agent antidotes for preventive purposes before contemplated exposure to a nerve agent.

The atropine auto injector consists of a hard plastic tube containing 2 mg (0.7 ml) of atropine in solution. It has a pressure activated coiled spring mechanism that triggers the needle for injection of the antidote solution. The 2 PAM Cl auto injector is a hard plastic tube, which dispenses 600 mg of 2 PAM Cl (300 mg/ml) solution when activated. It also has a pressure activated coiled spring mechanism identical to that in the atropine auto injector. Diazepam (CANA) is administered as a single-dose 10 mg autoinjector.

General Usage Principles for Nerve Agent Antidotes

Certain general usage principles should be followed in the administration of nerve agent antidotes. Complete instructions for the administration of nerve agent antidotes are found on the auto injectors and also in the Navy NAVMED P-5041.

SELF-AID.\If you experience most or all of the mild symptoms of nerve agent poisoning, you should IMMEDIATELY hold your breath (without first inhaling) and put on your protective mask. Then, administer one set of (atropine and 2 PAM Cl) injections into your lateral thigh muscle or buttocks as illustrated in figures 13-31 and 13-32. Position the

Figure 13-31.\Thigh injection site. 

needle end of the atropine injector against the injection site and apply firm, even pressure (not jabbing motion) to the injector until it pushes the needle into your thigh (or buttocks). Make sure you do not hit any buttons or other objects. Using a jabbing motion may result in an improper injection or injury to the thigh or buttocks.

Figure 13-32.\Buttocks injection sites.

Figure 13-30.\Nerve agent antidotes.

Hold the atropine injector firmly in place for at least 10 seconds. The seconds can be estimated by counting "one thousand one, one thousand two," and so forth. Firm pressure automatically triggers the coiled mechanism. This plunges the needle through the clothing into the muscle and at the same time injects the atropine antidote into the muscle tissue.

Next, inject yourself in the same manner with the 2 PAM Cl injector using the same procedure as you did for the atropine. This will now complete one set of nerve agent antidotes. Attach the used injectors to your clothing (fig. 13-33).

After administering the first set of injections, wait 5 to 10 minutes before administering the second set since it takes that long for the antidote to take effect. However, if you are able to walk and know who you are, you will not need a second set of antidote injections.

WARNINGS

Giving yourself a second set of injections may create a nerve agent antidote overdose, which could result in incapacitation.

If symptoms of nerve agent poisoning are not relieved after administering one set of nerve agent antidote injections, seek someone else to check your symptoms. A buddy must administer the second and possibly a third set of injections, if needed.

After administering one set of injections, you should decontaminate your skin if necessary, and put on any remaining protective clothing.