Chemical agent exposure
Procedure:
- Ensure personal safety.
- Separate patient from causative agent.
- Victim’s clothing should be removed and isolated by personnel wearing proper PPE.
- Victims should be decontaminated prior to transport whenever possible.
- For severely affected patients, perform rapid decontamination and provide treatment.
- ABCs / monitor cardiac rhythm.
- Check pupil size. Spinal immobilization if indicated. IV access, rate titrated to perfusion as needed.
Suspected Nerve Agent Exposure:
Duo Dotes (Atropine 2 mg auto-injector and Pralidoxime 600 mg auto-injector)
MILD / MODERATE SYMPTOMS: (Patients 14 - 65 years old)
- 1 to 2 Duo Dotes, IM at 10 minute intervals. Maximum 3 Duo Dotes.
If Duo Dotes are not available:
- Atropine: 2 - 4 mg IM/IV at 10 minute intervals as needed.
SEVERE RESPIRATORY SYMPTOMS: (Patients 14 - 65 years old)
- 3 Duo Dotes or Mark 1 kits, IM in rapid succession.
If Duo Dotes are not available:
- Atropine: 6 mg IM/IV repeat as needed.
Elderly Patients ( > 65 years) or Patients with underlying cardiovascular or renal disease:
- Atropine 1 mg IM. Repeat doses may be given at BH direction; IM or IV.
- Pralidoxime (2-PAM, Protopam) 7.5 mg/kg IM, to a maximum of 600 mg (one auto-injector) per dose.
- Elderly patients must weigh at least 80 kg to receive 1 auto-injector of Pralidoxime IM.
PEDS: (< 12 years):
Dose:
Atropine:
IV: 0.1 mg/kg IVP, minimum of 0.1 mg repeat once as needed (Max single dose 0.5mg)
IM: 0.1mg/kg IM repeat once as needed (Max single dose 0.5 mg)
Pralidoxime:
IV / IM: 20 mg/kg IM or IVP (must weigh at least 30 kg to receive 1 auto-injector IM)
If Prolidoxime powder 1 Gm for reconstitution is available:
Reconstitute as directed by BH or 20 mL sterile water w/o preservative to produce a concentration of 50 mg/ml.
Adult Patients: 1 Gm over 30 minutes IV or 600 mg - 1 Gm IM in divided injections if necessary.
Elderly Patients: 0.5 mg/kg IM or IV. Max IV dose is 1 Gm over 30 minutes. May repeat once in one hour.
PEDS: 20 mg/kg IM or IV. Max IV dose is 1 Gm over 30 minutes. May repeat once in one hour.