Transcript Chemical weapons and antidotes

Nerve agents & Mark 1
Auto injectors
Harbor-UCLA Medical Center
South Bay Disaster Resource Center
Objectives

At the end of this in-service
participants will be able to:
Describe potential chemical agents
used as weapons of mass destruction
 Discuss the clinical presentation of a
patient exposed to a nerve agent
 Demonstrate the use of a Mark 1
Nerve Antidote kit

Priorities in an “all hazards”
response

Life safety
• Safety of rescuers
• Safety of victims
• Appropriate decontamination and treatment of
victims
• Appropriate protection for staff/rescuers and
treatment if necessary
Incident coordination/stability
 Property preservation-evidence collection
 Protection of the environment

Initial treatment for nerve
agent exposure
Scene safety
 Immediate removal of victim from
source of exposure
 Direct proportional relationship
between absorbed dose and severity
of symptoms/morbidity & mortality
 Airway management is key
 Antidote administration
 Seizures

Nerve agent triage
Was Mark 1 given in the pre-hospital
treatment? How many?
 Signs and symptoms upon
presentation
 Initial symptoms improving?
 Is miosis still present
 Bronchorhhea present?

Minimal Treatment- Nerve
agent exposure
Patient exposed to nerve agent
 Recovering well from Mark 1 Kit
admininstration
 Walking and talking indicates
respiratory and circulatory status is
sufficient to maintain function

Expectant patients exposed
to nerve agents
Apneic for more than five minutes
 Seizures have already begun
 No pulse or blood pressure
 Patient has minimal to no chance of
survival no matter what treatment
 Patient is declared expectant (black
triage tag)

Signs and Symptoms:
SLUDGE
Over-stimulation of the nervous system
causes muscles and certain glands to
over-react
Salivation
 Lacrimation
 Urination
 Defecation
 GI Distress
 Excrement/Emesis

Effects of nerve agent on
victim



The nervous system controls body functions by
secreting chemical transmitters which act as
"instructions" to nerves, muscles and glands.
Nerve agent exposure -interferes with the
normal instructions of chemical transmitters that
direct the muscle or gland to return to an unstimulated, relaxed state.
Action of toxic nerve agents is to over-stimulate
the nerve endings and central nervous system.
Organophosphate poisonings
SLUDGE symptoms
 Cases we are familiar with in
healthcare due to frequent exposures
 Massive doses of Atropine
 Common with gardeners in hot house
environment
 Industrial plants
 Migrant farm workers exposed to
Malephyon

Nerve agent antidote
History of the Mark 1 Kit auto injectors
 Placement of Mark 1 Kits in
CHEMPACK and pharmaceutical
caches
 Dosaging- Adult and Pediatric
 Administration of Mark 1 Kit

Mark 1 Autoinjectors
Atropine: administered to block
receptor sites of acetylcholine
 2-PAM Chloride: restores
acetylcholinesterase
 Combo Pen/ Mark 1
 Package insert- review administration,
side effects

Mark 1 Kits
One chamber has 2mg of Atropine
 One chamber has 600 mg of 2 Pam
 Other auto injectors contain Valium for
seizure control

Signs &
Symptoms
Atropine Dose 2-Pam Dose
Monitor Interval
Severe Respiratory
Distress,
Agitation
SLUDGE
3 Auto-injectors (6 mg)
Monitor every 5 minutes
3 Auto-injectors
Respiratory Distress,
SLUDGE
2 Auto-injectors (4 mg)
Monitor every 10 minutes
1 Auto-injector
(600 mg)
Asymptomatic
None
Monitor for signs &
symptoms
every 15 minutes
None
(1.8 gms)
Source: New York Department of Health Policy Statement 03-05
Use of "Mark I Kits" (AtroPen Auto-Injector & Pralidoxime Chloride Injector)
How to obtain the Mark 1 Kits
at Harbor-UCLA Medical Center
Attending physician of ER declares a
Code Triage- overhead page for disaster
 Notification to pharmacy that
pharmaceutical caches are necessary
 Delivery of medications to ER
 Treatment of staff/victims
 Pharmacy notifies CDC that
CHEMPACK as been activated via
Sensaphone

Thank you for your attention
Please sign in on roster
 Please take three handouts
 For any further questions please notify
Dr. Amy Kaji [email protected] or
KathyCrow [email protected]
