Transcript Atropine Auto

Use of Auto-Injectors
by Civilian Emergency
Medical Personnel
to Treat Civilians
Exposed to Nerve Agent©
© 1997 Lockheed Martin Energy Research Corporation
Learning Objectives




Identify the antidotes to be administered in
event of nerve agent exposure
Identify the conditions under which antidote
auto-injectors should be used
Demonstrate use of antidote auto-injectors
Recognize adverse reactions to use of
antidotes
AI 2©
IMPORTANT!
Antidotes counter or relieve effects of poisons
such as nerve agents. Use antidotes only when
signs and symptoms of exposure are present;
they will not protect if given before exposure.
AI 3©
Auto-Injectors
Simple, compact injection systems
 Permit rapid injection of required antidotes
 Prevent needle from being subject to crosscontamination
 Enable rapid and accurate administration
even if care giver or patient is in protective
clothing
AI 4©
Auto-Injectors
Auto-injectors facilitate timely treatment by
providing
 Simple, accurate, rapid drug administration
 Pre-measured, controlled dose
 No vials, ampules or syringes to manipulate
 Fully automatic operation
 Rugged construction
AI 5©
Auto-Injectors


Contain pre-measured doses of nerve agent
antidotes atropine and 2-PAM chloride
(2-PAM Cl, pralidoxime chloride or
PROTOPAM® CHLORIDE)
FDA-approved and commercially available
for use by civilian emergency medical
personnel in the event of an accidental
release of nerve agent or organophosphorus
insecticides
AI 6©
Auto-Injectors


States decide if they will use them
One U. S.-based manufacturer: Survival
Technology Inc. (STI)
AI 7©
Who Can Use
Auto-Injectors

Concern about administration of
inappropriate and harmful doses
during emergency situations
• Pre-measured doses in auto-injectors safe for civilians
meeting profile of military personnel
– approximate ages of 18–35
– weight at least 70 kg or 154 pounds
– healthy with no compromising medical conditions

Age, sex, weight and health of all other
patients must first be considered when
determining amount of atropine and
2-PAM Cl to administer
AI 8©
Who Can Use Auto-Injectors


Only qualified civilian emergency responders
with adequate training in on-site recognition
and treatment of nerve agent intoxication in
the event of an accidental release
Majority of CSEPP States follow DOT national
curriculum for Emergency Medical
Technicians
• Curriculum generally restricts training on use of IVs to
Intermediate Emergency Medical Technicians and
paramedics

Review of each state’s laws and regulations
needed to determine appropriate use of autoinjectors
AI 9©
When To Use Auto-Injectors
Use only after following events have occurred:
 Emergency medical personnel have donned
personal protective equipment subsequent to
recognizing existence of chemical agent
hazard in area
 Some or all of symptoms of nerve agent
poisoning cited are present
AI 10©
Signs and Symptoms of Nerve
Agent Exposure









MILD
headache
blurred vision from pinpoint
pupils (miosis)
tight chest (smooth muscle
constrictions)
excessive sweating
tearing (lacrimation)
salivation
unexplained runny nose
MODERATELY SEVERE
severe chest tightness
diarrhea (rare)
Cinetel Productions





VERY SEVERE
bluish discoloration
of skin (cyanosis)
respiratory failure
coma
unconscious
convulsions
AI 11©
Treatment For Exposure
To Nerve Agents

Depending on severity of symptoms,
immediately administer 1 atropine autoinjector, followed by 1 2-PAM Cl auto-injector
• Atropine should be given first, followed immediately by
2-PAM Cl

If nerve agent signs and symptoms are still
present after 5–10 minutes, repeat injections
AI 12©
Treatment For Exposure
To Nerve Agents


If signs and symptoms still exist after
additional 10 minutes, repeat injections for
third time
If signs and symptoms remain after third set
of injections, do not give any more antidotes
but seek immediate medical help
AI 13©
Treatment For Exposure
To Nerve Agents
If severe signs and symptoms are present:
 In case of very severe exposure, all three autoinjector kits (atropine and 2-PAM Cl) should be
administered in rapid succession; then medical help
should be sought
 Remove secretions, maintain patient’s airway and,
if necessary, use artificial ventilation
 2-PAM Cl is most effective if administered
immediately after poisoning. Generally, little is
accomplished if drug is given more than 6 hours
after termination of exposure
AI 14©
Directions for Use
1. Remove safety cap (yellow on
atropine; gray on 2-PAM Cl).
Mark I kit clip holds the safety
caps; may not notice if using
Mark I kits. Do not touch colored
end of injector after removing
cap; injector can and will function
into fingers or hand if any pressure applied
to this end of injector
AI 15©
Directions for Use
2. Hold injector like a pen. Place
colored end (green on
atropine, black on
2-PAM Cl) on
thickest part of thigh and
press hard until injector
functions
•Pressure automatically activates the
spring, plunges the needle into the
muscle and simultaneously forces
fluid through it into the muscle tissues
AI 16©
Directions for Use
3. Hold firmly in place for ten
seconds, then remove.
Massage the area of injection
AI 17©
Directions for Use
4. After auto-injector has been activated,
empty container should be disposed of
properly
•It cannot be refilled nor can the protruding
needle be retracted
•It should be disposed of in a “sharps” container
per rules for handling medical wastes and possible
blood-borne pathogens
Note dosage on triage tag or write on
chest or forehead of patient
AI 18©
Directions for Use
IMPORTANT: Medical personnel assisting
evacuated victims of nerve agent exposure
should avoid exposing themselves to crosscontamination by ensuring that they do not
come in contact with patients’ clothing
AI 19©
Precautions


Place any patient receiving atropine under
medical observation for at least 24 hours
If atropine is used to treat infants, smaller
amounts should be given
AI 20©
Adverse Reactions

2 to 5 minutes after
intramuscular injection of
2-PAM Cl, mild to
moderate pain may be
experienced at site of
injection
AI 21©
Adverse Reactions
2-PAM Cl in a normal person may cause:
•
•
•
•
•
blurred vision
impaired accommodation
headache
nausea
increased systolic and
diastolic blood pressure
•
•
•
•
•
double vision (diplopia)
dizziness
drowsiness
rapid heart rate (tachycardia)
hyperventilation
These are relatively non-toxic responses when
compared to effects of nerve agent or
organophorus insecticide exposures
AI 22©
Overdosage
If excessive atropine is administered to a
normal person:
 Signs of atropinization will become even
more severe and patient may also develop
• blurring of vision
• delirium
• urinary retention

When signs and symptoms of atropinization
develop, no more atropine should be injected
until atropinization subsides
AI 23©
Overdosage
In case of 2-PAM Cl:
 Observed in normal subjects only
•
•
•
•
•
•
•

dizziness
blurred vision
double vision (diplopia)
headache
impaired accommodation
nausea
slightly rapid heart rate (tachycardia)
Artificial respiration and other supportive
therapy should be administered as needed
AI 24©
Caring For Auto-Injector Supplies



Auto-injectors have a five-year shelf life,
making them suitable for storage in
emergency stockpiles
Store auto-injectors at room temperature
(approximately 25°C, 77°F)
Keep them from freezing
May
AI 25©
Caring For Auto-Injector Supplies




Antidotes will freeze at temperatures below
29F
Do not carry auto-injectors in external pocket
of BDO when temperature below freezing.
Place in inner pocket where body heat will
keep them warm
Tie string to auto-injector and thread through
outer layers of clothing to outside pocket or
belt. Extract auto-injector by pulling the
string when needed
Frozen auto-injectors still usable after being
thawed if they do not appear broken or
cracked
AI 26©