injuries and poisoning
Nerve Chemical Warfare Agents
Treatment of Nerve Chemical Warfare Injuries
Injections ofatropineand pralidoxime Two drugs,atropineand pralidoxime, can be given for exposure to a nerve agent.Atropineblocks the effects of excessive amounts of the neurotransmitter acetylcholine, which builds up as the result of exposure. Thus,atropineis termed an anticholinergic drug. Pralidoxime and a new drug, MMB-4, help reactivate the enzyme that breaks down acetylcholine. Before reaching a hospital, prehospital providers can use an autoinjector containing both these drugs to inject the drugs into a large muscle (such as the thigh). Subsequent doses of the drugs are given intravenously. Benzodiazepines (eg,diazepamormidazolam) are available in autoinjector form and should be given to anyone with seizures. They should also be administered to any patient requiring the full initial three doses ofatropineand an oxime (pralidoxime or MMB-4) even if there are no seizures. The skin is decontaminated as soon as possible using a specially formulated commercial topical skin-decontamination product (called Reactive Skin Decontamination Lotion, or RSDL®), a dilute solution of household bleach, or soap and water. First responders inspect any possibly contaminated wounds, remove all debris, and flush the wound with plain or salt water. Severe symptoms and death may still occur because decontamination may not completely remove nerve agents that have already started to pass through the skin. Doctors typically treat poisoning with nerve agents by aggressively and carefully monitoring people's heart rates, core temperatures, and enzyme levels throughout treatment. The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government. 