**Meticulous attention to standard protocols for personal protection, recognizing toxidromes, and treating patients continues to be the best way to prepare for and respond to chemical agent exposures**
Purpose
This document provides a quick refresher on standard protocols for recognizing, treating, and protecting yourself from nerve agent exposures. Comprehensive follow-up guidance for Law Enforcement, Fire, EMS, HazMat, and Hospital-Based First Receivers incorporating lessons learned and best practices from the recent United Kingdom incidents will be forthcoming.
Background
Nerve agents are extremely toxic chemical warfare agents. Several nerve agents exist and are generally categorized as either “high volatility” or “low volatility” chemicals, a measure of how likely they are to disperse in air. A high volatility nerve agent (easily dispersed in air) means that the exposure is likely to occur from breathing in its vapors resulting in the rapid onset of symptoms.
A low volatility nerve agent (not easily dispersed in air) typically gets absorbed through the skin and has a delayed onset of signs and symptoms. An example of a high volatility nerve agent is sarin, whereas VX is a low volatility agent. In the body, a nerve agent exerts its effects by inhibiting an enzyme (acetylcholinesterase), resulting in acute illness – specifically, cholinergic crisis.
Organophosphorus or carbamate pesticides produce similar effects to nerve agents.
FULL DOCUMENT CAN BE FOUND HERE
SIGNS AND SYMPTOMS OF NERVE AGENT POISONING
Caveat: Poisoned patients may not demonstrate all of these symptoms
- Mouth/Skin: Drooling (Salivation), foaming at the mouth, and excessive sweating
- Nose/Eyes: Runny nose and watery eyes (Lacrimation) with small (often pinpoint) pupils (Miosis)
- Chest: Cough, chest tightness, difficulty in breathing, wheezing, respiratory failure, “wet” fluid filled lungs
- Abdominal: Urination, Diarrhea, abdominal (Gastrointestinal) cramps, belching, nausea, and/or vomiting (Emesis)
- Mental Status: Confusion, drowsiness, slurred speech, ataxia, unconsciousness, coma
- Muscle/Neurological: Fatigue, weakness, twitching, tremors, cramps, absent reflexes, seizure
- Underlined findings = “SLUDGE”- Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal cramps, Emesis
- Other mnemonic used = “DUMBBELS” – Diarrhea, Urination, Miosis/Muscle weakness, Bronchospasm/Bronchorrhea, Bradycardia, Emesis, Lacrimation, Salivation/Sweating