act001©. a a gent c c haracteristics and t t oxicology f f irst a a id and s s pecial t t reatment...

ACT001©

AA gentCC haracteristics andTT oxicology

FF irstAA id andSS pecialTT reatment ACT002©

Purpose of Purpose of CourseCourse

The intent of this course is to instruct emergency medical personnel on how to care for patients that may have been exposed to chemical warfare agents and assumed to have already been decontaminated. This course is designed primarily for Emergency Medical Technicians with basic life support credentials.

These individuals are referred to in the text as pre-hospital emergency medical personnel.

ACT002B©

To prepare you to recognize signs and symptoms, and provide initial emergency response treatment to patients injured by exposure to nerve and blister agents

GoalGoal

ACT003©

To assist in preparing for hazardous materials emergencies

GoalGoal

ACT004©

• Action items

• What trainees will be able to do at end of training

• Review with trainees

Instructional Instructional ObjectivesObjectives

ACT005©

• DESCRIBE initial first-aid treatment for victims of nerve agent exposure

• DESCRIBE initial first-aid treatment for victims of blister agent exposure

Required ObjectivesRequired Objectives

ACT006©

• DESCRIBE potential hazards of nerve agents

• DESCRIBE potential hazards of blister agents

• IDENTIFY signs and symptoms of nerve agent exposure

• IDENTIFY signs and symptoms of blister agent exposure

Supporting ObjectivesSupporting Objectives

ACT007©

• Designed to augment classroom instruction

• Self-paced review

• Self checks included

• Additional reference materials such as Material Safety Data Sheets included

Student ManualStudent Manual

ACT008©

• Self-checks

• Final quiz

EvaluationsEvaluations

ACT009A©

BACKGROUNDBACKGROUND

BACKGROUNDBACKGROUND

ACT010©

To familiarize you with chemical agent characteristics

PurposePurpose

ACT011©

• Comprised of chemicals designed and produced for warfare

• Primarily nerve agents and blister (vesicant) agents

Chemical StockpileChemical Stockpile

ACT012©

•

•

•• •

•••Hermiston, OR

Tooele, UTPueblo, CO

Aberdeen, MDNewport, INRichmond, KY

Pine Bluff, ARAnniston, AL

Chemical Stockpile Storage Chemical Stockpile Storage LocationLocation

ACT013©

U.S. Army ChemicalStockpile

InventoriesStorage Location Agent Stored

GA GB VX Mustard Lewisite Umatilla X X X Tooele X X X X X

Pueblo X Pine Bluff X X X

Newport X

Lexington- Blue Grass X X X

Anniston X X X Aberdeen X ACT014©

LOCAL RESPONSE LOCAL RESPONSE

INFORMATION AND INFORMATION AND

PROCEDURES PROCEDURES

LOCAL RESPONSE LOCAL RESPONSE

INFORMATION AND INFORMATION AND

PROCEDURES PROCEDURES

ACT015A©

• Specific and unique information requirements to be addressed

• Provide you with a framework for site-specific information

Local Response Local Response Information and Information and

ProceduresProcedures

ACT015B©

Community needs and resources vary a great deal from one storage location to the next. Therefore, YOUR input on how the emergency care elements in your community could best respond to a release with off-post consequences is important to the success of the program.

Your Input is ImportantYour Input is Important

ACT015C©

• This study guide does not, and cannot, cover everything you need to know in preparation for your role

• In short, you need to find out

— Who the local players are — The roles and responsibilities of each — The methods of response — What supplies and equipment are on hand — Standard Operating Procedures — Memoranda of Understanding or Agreement

What You Should Know What You Should Know That IS NOT in This Study That IS NOT in This Study

GuideGuide

ACT015D©

• Local emergency services

• Fire department or other emergency responders

• Ambulance service or other rescue services

• Hospital emergency department

• Local health department

Additional Information Additional Information ResourcesResources

ACT015E©

• Where is the first notification (identification) expected to come from?

• Who, from the facility, is notified?

• Who, from the local community, is notified?

• Who is likely to be the first on the scene?

If an emergency occurs at the installation that could affect the off-post population:

Local Community Local Community Response ProceduresResponse Procedures

ACT015F©

• What are the duties of the pre-hospital emergency medical personnel?

• What am I expected to do in this situation?

• Am I authorized in my state to administer antidotal medications (atropine, 2-PAM chloride)? Under what circumstances?

If an emergency occurs at the installation that could affect the off-post population:

Local Community Local Community Response Procedures Response Procedures

(Continued)(Continued)

ACT015G©

CHEMICALAGENTS

ACT017©

Information will help you in:

• Protecting yourself

• Treating patients

ACT018©

• DESCRIBE potential hazards of nerve agents

• DESCRIBE potential hazards of blister agents

• IDENTIFY most likely route of exposure

ObjectivesObjectives

ACT019©

AND EFFECTSCHARACTER STICSI

ACT020©

Nerve Agents

• Attack nervous system

• Scientific classification: Organophosphate

© Cinetel Productions

ACT021©

Name Common Name Referred to As

VX VX

GB Sarin GB or G-agent

GA* Tabun GA or G-agent

* Small amount stored at Tooele only

Specific NamesSpecific Names

ACT022©

• Usually liquid in normal state

• Volatile--generate vapors

• Potential for release if in vapor form

Physical PropertiesPhysical Properties

ACT023©

• Nervous system controls normal functions through use of chemicals

• Chemicals act as instructions to nerves, muscles, and glands

• Two forms of instructions: - stimulate (move or work) - relax (stop or rest)

• Nerve agent interferes with normal transmission of instructions

How Nerve Agents WorkHow Nerve Agents Work

ACT024©

• Over-stimulates nerve endings and central nervous system

• Causes muscles and certain glands to malfunction

Leads to Destruction of Leads to Destruction of System ControlSystem Control

ACT025©

• Nerve impulse transmitted

along nerve cells

Normal Nervous System Normal Nervous System FunctionFunction

ACT026A©

• Acetycholine (a neuro-transmitter) is released

• Target cell is stimulated

Normal Nervous System Normal Nervous System FunctionFunction

• Once target cell is stimulated, acetycholine is deactivated by acetylcholinesterase.

• Target cell relaxesACT026B©

• Nerve agents inactivate acetylcholinesterase

Nerve Agent InterferenceNerve Agent Interference

ACT027©

• Excess acytelcholine accumulates

• Muscle action becomes uncontrolled and twitchy

• Muscle can tire and collapse

• Gland continues to secrete sweat, tears, or mucus

• Inhalation

• Ingestion

• Direct contact


Routes Routes of of

ExposureExposure

ACT028©


InhalationInhalation

ACT029©

Respiratory failurechief cause of death

after severe exposure

Absorption through skin:

• All agents can be absorbed

• VX persists longer

• GB evaporates quickly, but still threat

• Scrape or cut in skin allows immediate entry

Entry also through eyes


Direct Direct ContactContact

ACT030©


• Access to bloodstream via digestive system

• Effects similar to inhalation, but at greater doses

IngestionIngestion

ACT031©

The critical route of exposure that you shouldbe most concerned with is

Inhalation Exposure From Inhalation Exposure From Atmospheric TransportAtmospheric Transport

ACT032©

*inhalation of agent vapors or aerosols*

• Poisons that destroy cells

• Blisters most noticeable effect


Blister Agents Blister Agents (Vesicants)(Vesicants)

ACT033©

Common Name Referred to as

Mustard H, HD, HT

Lewisite* L

*Small amount stored at Tooele only

Specific Specific NamesNames

ACT034©

• Form: Liquid or solid

• Volatile, burns well

H

HD

HT

Physical PropertiesPhysical Properties

ACT035©

• Chemical burns to skin–especially warm, moist surfaces

• Chemical burns to soft membranes

- Eyes

- Eye ball

- Lung tissue

- Mouth

- Throat

How Blister Agents WorkHow Blister Agents Work

ACT036©

• Delayed reaction, little or no pain

• Blisters develop in 2 to 36 hours


Mustard Agent ExposureMustard Agent Exposure

ACT037©

• Inhalation

• Ingestion

• Direct contact


Routes Routes of of

ExposureExposure

ACT038©

Can destroy mucous membrane lining of

• Nasal passages

• Throat

• Bronchial tubes



ACT039©

Skin

• Highly damaging to skin—especially warm, moist areas

Mucous Membranes

• Very susceptible to effects of blister agents

• Includes: - lining around eyelids - inside mouth and nose

Sweat and moisture increase effect

Direct contact Direct contact With Liquid or VaporWith Liquid or Vapor

ACT040©

• If deposited on or in food items, drink, etc.

• Injures warm, moist tissues of mouth, throat and esophagus


IngestionIngestion

ACT041©

The critical route of exposure that you shouldbe most concerned with is

Inhalation Exposure From Inhalation Exposure From Atmospheric TransportAtmospheric Transport

ACT042©

*inhalation of agent vapors or aerosols*

• Chlorovinyldichloroarsine (organic arsenical)

• Different type of blister agent in Chemical Stockpile only at Deseret Chemical Depot

• Causes immediate pain upon skin or eye contact (unlike mustards)

• Suspected carcinogen

LewisiteLewisite

ACT043©

• Nerve agent characteristics:

- Stored as liquid (VX oily), generates extremely damaging vapors

- Highly damaging by direct contact (touch), inhalation (breathing of contaminated air), and ingestion (eating or drinking)

Key Points—Nerve AgentsKey Points—Nerve Agents

ACT044A©

H

HD

HT

• Blister agent characteristics:

- Stored as liquid (oily) or solid, generate damaging vapors

- Damaging by direct contact (touch), inhalation (breathing of contaminated air), and ingestion (eating or drinking)

Key Points—Blister AgentsKey Points—Blister Agents

ACT044B©

Most likely route of exposure:

• Inhalation of contaminated air

Key Points—ExposureKey Points—Exposure

ACT045©

SIGNS ANDSYMPTOMS

ACT046©

• Known information regarding accidental release

• Recognition of the event based on signs and symptoms

Size up situation based on . . Size up situation based on . . ..

ACT047©

• IDENTIFY signs and symptoms of nerve agent exposure

• IDENTIFY signs and symptoms of blister agent exposure


ACT048©

Not all signs and symptoms may appear...

Dose, duration, and route of entry make a difference

Note!Note!

ACT049©

• Miosis (pinpoint pupils)

• Dim vision

• Respiratory trouble

• Localized sweating

• Wheezing

Constriction (Pinpoint)

Expansion (Dilation)

• Runny nose or excess salivation

• Stomach cramps, vomiting diarrhea

• Muscle cramps, twitching

• Heartbeat irregularities

Specific Signs and Specific Signs and Symptoms Symptoms

Of Nerve Agent ExposureOf Nerve Agent Exposure

ACT050©

• Generalized weakness

• Twitching spasms

• Convulsions and coma

• Other symptoms - Headache - Anxiety - Restlessness - Giddiness - Irritability

Mild:

Specific Signs and Symptoms Specific Signs and Symptoms Of Nerve Agent Exposure Of Nerve Agent Exposure

(continued)(continued)

ACT051©

• Reaction time depends on:

- type of agent involved

- amount of agent to which patient exposed

- dose (how much patient absorbed)

- duration

- route of exposure

- sensitivity of patient's system

Time Factor (Onset)

Factors Affecting Factors Affecting Signs and SymptomsSigns and Symptoms

ACT052©

• Reaction time is immediate if:

- moderate to large amounts inhaled

- moderate to large amounts spilled on skin

• Reaction time is delayed if:

- small amounts involved

- absorbed through skin in localized area

Time Factor (Onset)

Factors Affecting Signs and Factors Affecting Signs and Symptoms (Continued)Symptoms (Continued)

ACT053©

• Effects can occur after single breath

• Immediate response within seconds

• Peak effects within 15-20 minutes


Exposure Through InhalationExposure Through Inhalation

ACT054©

• Effects can develop up to 18 hours after exposure

• Absorption can continue and effects worsen for hours, even after decon

• Later onset, less likely to be lethal© Cinetel Productions

Exposure Through Skin Exposure Through Skin (Absorption)(Absorption)

ACT055©

• LD50 of VX is 10 milligrams/70-kg man (liquid on skin)

– Equals tiny droplet absorbed into 155-lb person

• LCt50 of VX is 30 milligrams-min/m (vapor inhalation)

– 50 times more toxic than cyanide gas

• LD50 of GB is 1.7 grams/70-kg man (liquid on skin)

• LCt50 of GB is 70 milligrams-min/m (vapor inhalation)

ToxicityToxicity

ACT056©


Respiratory failurechief cause of death

after severe exposures

LethalityLethality

ACT057©

Nerve Agent Exposure Nerve Agent Exposure LevelsLevels

Mild:

May also be effects of initial reaction which could lead to more serious effects

eyes: miosis, pain (deep in eye or head), dim or blurred vision

nose: runny

lungs: "tightness in chest”, bronchoconstriction, secretions in airways, cough, moderate

difficulty in breathing

ACT058A©


Moderate:

May also include symptoms under "Mild"

eyes: miosis, pain, dim or blurred vision

nose: runny (severe), nasal congestion

lungs: ”tightness in chest", breathing more difficult, secretions more abundant

muscles: feeling of generalized weakness , twitching of large muscle groups

GI: nausea, vomiting, diarrhea, cramps

ACT058B©

Severe:

May develop from symptoms under "Mild" and "Moderate"; or go directly to these symptoms

muscles: convulsions, weakness with eventual flaccid paralysis

lungs: cessation of respiration

all: loss of consciousness, coma, death


ACT058C©


Onset time: seconds to several minutes • Symptoms may occur after little more than one breath of vapor • Large amounts may cause reactions within seconds

• Effects do not worsen appreciably after 15-20 min following cessation of exposure

ACT058D©

Skin Exposure to Nerve Skin Exposure to Nerve AgentAgent

Mild:

May also be effects of initial reaction which could lead to more serious effects

skin: sweating at exposure site muscle: localized, unorganized twitching at exposure site (fasciculation)

ACT058E©


Moderate:

May also include symptoms under “Mild”

muscle: generalized (at random, all over) fasciculation

and twitching; generalized weakness that increases with any form of activity

GI: nausea, vomiting, diarrhea

ACT058F©


Severe:

May develop from symptoms under "Mild" and "Moderate"; or go directly to these symptoms

muscle: extremely weak; convulsions (seizures) with eventual flaccid paralysis

lung: cessation of respiration

all: sudden loss of consciousness and collapse, death

ACT058G©

Skin Exposure to Nerve Skin Exposure to Nerve Agent Time CourseAgent Time Course

Onset time: minutes to several hours • The larger the exposure the shorter the onset time • After large exposure, effects within minutes

• After asymptomatic period, first effect may be loss of consciousness • Onset time may be as long as 18 hrs after exposure; in such cases effects usually not lethal

ACT058H©

... refers to distinguishing one disease from another when they produce similar effects

Differential diagnosis . . .Differential diagnosis . . .

ACT059©

Signs and symptoms could also apply to:

• Epilepsy

• Gastroenteritis

• Exposure to agricultural insecticides (organophosphates and carbanates)

• Heat illnesses

• Emphysema

• Stroke

• Head trauma

• Drug overdose

Other Possible Causes of Other Possible Causes of SymptomsSymptoms

ACT060©

While liquid deposition of mustard agent or high concentrations of vapor are not expected, it is important to recognize the signs and symptoms of more severe exposures

Blister Agent Release Blister Agent Release PotentialPotential

ACT061A©

• Eye irritation and inflammation

• Photophobia

• Erythema

• Blisters

• Inflammation of respiratory tract

Specific Signs and Specific Signs and Symptoms of Mustard Agent Symptoms of Mustard Agent

ExposureExposure

ACT061B©

Normal skin

Reddened skin

Blistered skin


How Mustard Blisters SkinHow Mustard Blisters Skin

ACT061C©

Time Factor (Onset)

• Reaction time depends on:

- type of agent

- amount of agent to which patient exposed

- dose (how much patient absorbed)

- duration of exposure

- route of exposure

- sensitivity of patient's system

Factors Affecting Factors Affecting Signs and SymptomsSigns and Symptoms

ACT062©

Inhalation

• Effects occur after few hours latency

• Sneezing, coughing, bronchitis

Skin Absorption

• Effects delayed and absorption can continue for hours

Peak EffectPeak Effect


ACT063©


Peak Effect (Continued)Peak Effect (Continued)Toxicity

• LD50 is 7 grams/70-kg man (liquid on skin)

• Between 4 and 32 micrograms/70-kg man can cause blistering

• Vapor form 3 times more toxic than cyanide

Lethality

• Low (~3% in World War I)

• Chief cause of death: - Respiratory failure - Infections

ACT064©

skin: no immediate clinical effects (no burning, stinging, or redness); becomes "fixed" to the tissue within minutes, blisters appear about 2 to 36 hours later

eyes: within 4 to 12 hours after exposure, itching,tearing, conjunctivitis (reddening of tissuessurrounding the eyeball), sensation of grit inthe eye, burning and photophobia (sensitivityto light), some swelling of eyelids

Mild:

Mustard Agent Exposure Mustard Agent Exposure LevelsLevels

ACT065A©

Moderate:


skin: no immediate clinical effects; blisters appear sooner and are more severe than in cases of "mild" dose

eyes: in 3 to 6 hours; increased intensity from "Mild" symptoms;swelling of lids to the point of near closure; spasms of themuscles surrounding the eye; increased photophobia; blurred vision; possible discharge; miosis; severe inflammation of conjuctiva and cornea

ACT065B©

skin: no immediate clinical effects blisters appear sooner and are large necrosis skin charring (delayed)

eyes: severe pain increased swelling of lids to point of closure, discharge possible damage to cornea

Muscles: large amounts may affect nerve endings

Severe:


ACT065C©

Mild:

nose, throat and windpipe: burning sensation, sinus pain, cough GI: nausea and vomiting

Mustard Agent Exposure Mustard Agent Exposure Through Inhalation/IngestionThrough Inhalation/Ingestion

ACT065D©

Moderate:

nose, throat and windpipe: burning sensation

lungs: chest tightness, severe cough GI: nausea and vomiting, stomach pains


ACT065E©

Severe:

nose, throat and windpipe: severe burning

lungs: difficulty breathing due to airway damage GI: nausea, vomiting, bloody diarrhea, stomach pains

muscles: large amounts may affect nerve endings


ACT065F©

• Onset of symptoms may be delayed - initial signs/symptoms: 2 to 36 hrs, acute tracheobronchitis • Approximate for moderate exposure: - 2 to 4 hrs—chest tightness, hacking cough, hoarseness, sneezing - 4 to 16 hrs—sinus pain, increased respiration rate - 16 to 48 hrs—severe cough, unable to speak, very rapid breathing - 24 to 48 hrs—severe dyspnea, lung tissue hemorrhage, bronchopneumonia

Mustard Agent Exposure Mustard Agent Exposure

Time CourseTime Course

ACT066©

In spite of its chemical differences from mustard agents, Lewisite produces similar damage in bodytissues.

Lewisite Signs and Lewisite Signs and SymptomsSymptoms

ACT067A©

• When inhaled, vapor may produce mild to moderate irritation of upper respiratory tract

• May also cause sneezing

• Similar to mustard effects

— Except, in most severe cases, fluid may accumulate in lungs and ooze into lining of the chest cavity

Inhalation of Lewisite VaporInhalation of Lewisite Vapor

ACT067B©

• Immediate severe pain upon contact with eyes and skin (unlike mustard)

• Eyes can be severely damaged resulting in permanent injury of blindness

• More severe skin lesions than mustard

— Erythema followed by blistering over entire area of erythema

— Deeper injury to connective tissue and muscle

— Greater vascular damage

— More inflammation

Direct Contact with Direct Contact with Liquid LewisiteLiquid Lewisite

ACT067C©

• Systemic poison (liver and kidneys) at sufficiently large doses

• Has induced Bowen’s disease (slow-growing, usually nonfatal skin cancer)

Other EffectsOther Effects

ACT067D©

eye: prompt redness, swelling, irritation, immediate burning sensation, may cause inflammation of iris, corneal injury

nose: prompt irritation

respiratory tract: rapid irritation, hoarseness, loss of voice, cough; pneumonia, fever, accumulation of fluid in lungs, fluid between membranes liningchest cavity

Lewisite ExposureLewisite Exposure

ACT067E©

skin: prompt burning redness within 30 min, blisters on 1st or 2nd day; pain more severe and necrosis deeper than mustard

GI tract: diarrhea, nausea, vomiting, liver failure

cardiovascular system: shock after severe symptoms, anemia, concentration of blood

Lewisite Exposure Lewisite Exposure (Continued)(Continued)

ACT067F©

bladder: kidney failure

central nervous system: malaise, prostration, depression after severe symptoms

Lewisite Exposure Lewisite Exposure (Continued)(Continued)

ACT067G©

• Hay fever

• Chemical or thermal burns

• Heavy tear gas exposure

• Poison ivy, poison oak, and other contact allergies

Blister agent signs and symptoms could also apply to:

Other Possible Causes Of Other Possible Causes Of Signs and SymptomsSigns and Symptoms

ACT068©

• Specific signs and symptoms of nerve agent exposure

- Miosis

- Increased secretions

- Respiratory difficulty

• Not all signs and symptoms may appear

• Dose, duration, and route of entry can make difference

Nerve Agent SummaryNerve Agent Summary

ACT069A©

• Specific signs and symptoms of blister agent exposure

— Eye irritation and inflammation

— Erythema (skin reddening)

— Blisters

— Respiratory irritation and distress

• Not all signs and symptoms may appear

• Dosage, duration, and route of entry can make difference

Blister Agent SummaryBlister Agent Summary

ACT069B©

• DESCRIBE need for self protection when providing treatment for nerve or blister agent exposure

• DESCRIBE initial first aid treatment for victims of nerve agents

• DESCRIBE initial first aid treatment for victims of blister agents


ACT072©

• Recognizing area with exposure potential and the zone set up to operate safely during the emergency

• Ensuring that the exposed person is completely decontaminated

You Can Protect Yourself By:You Can Protect Yourself By:

ACT074A©

Once chemical plume expected to cross borders of post:

• Initial hazard prediction given, identifying pattern and path of off-post exposure

• Emergency response and treatment teams established

Emergency Time LineEmergency Time Line

ACT074B©

• It is assumed that patients will have been decontaminated before being brought to EMS personnel in the cold zone

• Information regarding decontamination or removal from contaminated areas should not be interpreted as encouraging EMS personnel to go into the hot zone

• PPE may be required. The CSEPP training course, Personal Protective Equipment, describes the approved equipment and associated requirements

ACT074C©

• Essential part of treatment

• Prevents agent from doing further harm

• Prevents agent from spreading

Note: Should be accomplished before patient is brought to the treatment area

DecontaminationDecontamination

ACT075©

• Laws vary from state to state

• Be familiar with YOUR local and state laws

Administering DrugsAdministering Drugs

ACT076©

Atropine EffectAtropine Effect

• Atropine blocks effects of over-stimulation

• Relieves smooth muscle constriction

• Dries up respiratory secretions

ACT078©

2-PAM Chloride Effect2-PAM Chloride Effect

• Removes organophospate from acetylcholinesterase which can then deactivate acetylchline

• Re-establishes normal skeletal muscle contraction• Relieves twitching and paralysis of respiratory muscles

ACT079©

Administration of Administration of AntidotesAntidotes

Dosage varies depending on age and weight of patient and severity of signs and symptoms

Dosages may need to be repeated at specified intervals– repeat atropine until patient is “atropinized”– repeat 2-PAM Chloride until maximum dose

per body weight is reached

ACT080©

Two Common ProblemsTwo Common Problems

Underdosage– administering too little antidote to

relieve agent effects– most serious problem: failing to

administer atropine when needed Administering antidote to patients

not exposed to nerve agent

ACT081©

Additional Drug Therapy— Additional Drug Therapy— DiazepamDiazepam

Administer to patients experiencing convulsions

Consider for patients with severe signs and symptoms

Dosage depends on patient’s age

ACT082©

• Make sure atropine warranted

• Administer dosages of antidotes as recommended in treatment tables

• Continue administering atropine as recommended in treatment tables until atropinization is achieved

• If needed, repeat dosage of 2-PAM Chloride as recommended in treatment tables until maximum total dose is given

Guideline For Guideline For Administering AntidotesAdministering Antidotes

ACT083©

Atropine OverdoseAtropine Overdose

Cause: Atropine administered when no prior nerve agent exposure has occurred

Not as serious as underdosing Not usually life-threatening

ACT085©

• Dilated pupils

• Dry mouth and skin

• Rapid pulse

• Flushed skin

• Difficulty urinating

• Confusion, delirium

• Temperature control diminished

• Intense thirst

• Restlessness

Signs and Symptoms Of Signs and Symptoms Of Atropine OverdoseAtropine Overdose

ACT086©

• Heat stroke

• Locoweed

• Atropine-like medicines

Other Possible Causes of Other Possible Causes of Symptoms Similar To Atropine Symptoms Similar To Atropine

OverdoseOverdose

ACT087A©

• Keep cool

• Protect from irrational actions

• Transport to hospital as soon as possible

Treatment for Atropine Treatment for Atropine OverdoseOverdose

ACT087B©

Auto-injectors approved for civilians by Food and Drug Administration

- Simple, compact, injection systems equipped with pre-measured amount (dose) of antidote

- Atropine auto-injectors approved for adults and children, but not infants

- 2-PAM chloride auto-injectors approved for adults only

Alternate Method of Alternate Method of Administration of AntidoteAdministration of Antidote

ACT088©

• Required only if exposure is severe

• Range from administering oxygen (if breathing is difficult) to providing ventilation, airway management and suction as needed

Respiratory SupportRespiratory Support

ACT089©

• If required, insertion of endotracheal tube by a qualified person is recommended

• Requires higher “pop off” pressure (70+ cm H2O)

Source: DOT Emergency Medical Care--Paramedic

VentilationVentilation

ACT090©

• Ensure patient is thoroughly decontaminated

• Take precautions for sterile technique

• Support airway management as necessary

After protecting yourself, immediately

Treatment For Exposure Treatment For Exposure To Blister AgentTo Blister Agent

ACT091©

• Flush eyes immediately

• Do not cover eyes with bandages

• Dark or opaque glasses provide relief from photophobia

SPEED CRITICAL!

- Tilt head to the side- Pull eyelids apart with fingers- Pour water slowly into eyes

Eye ContactEye Contact

ACT092©

Arm pits

Groin

Behind knees

Between toes

Pay special attention to

Around ears

Eyelids

Inside nose

Inside mouth

Neck creases

Skin ContactSkin Contact

ACT093©


Supply respiratory support if needed for significant inhalation exposure

Administer oxygen as needed If breathing has stopped, resuscitate

the person Give intravenous fluids if needed, but

do not overloadACT094©

• Decontaminate exposed person immediately to avoid deep burns

• Antidote has been developed but is no longer manufactured

Treatment For Exposure to Treatment For Exposure to LewisiteLewisite

ACT095©

• PROTECT SELF

• Initial first aid for nerve agent exposure

- Give atropine, follow up with 2-PAM chloride - Support airway management as necessary - Atropine overdose possible if given when no nerve agent exposure occurred

• Initial first aid for blister agent exposure

- Ensure that patient is decontaminated - Take precautions for sterile technique - Support airway management as necessary

Key PointsKey Points

ACT096©

act001©. a a gent c c haracteristics and t t oxicology f f irst a a id and s s pecial t t reatment...

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