CHEMICAL

SYMPTOMS

TREATMENT

Nerve Agents

Tabun

Sarin

Soman

VX

Salivation.

Lacrimation.

Urination.

Defecation.

Gastric -

Emptying.

Pinpoint pupils (everything looks dark).

Seizures.

Atropine – initial dose 2 mg. Additional doses until symptoms resolved (will not reverse miosis).

Pralidoxime Chloride – 1 gram IV over 20–30 minutes.

Benzodiazepines – for seizure control or to prevent seizures in severely intoxicated patients.

Cyanides

Hydrogen Cyanide

Cyanogen Chloride

Non-specific: anxiety, hyperventilation, respiratory distress.

Cherry-red skin, though classic, is seldom seen.

Lactic acidosis and increased concentration of venous oxygen.

Cyanide Antidote Kit

Amyl nitrite ampule – first aid until IV established.  Crush and place inside mask of BVM; 15 seconds of inhalation, then 15 second break; repeat until IV established.

Sodium nitrite – 300 mg over 2–4 minutes.

Sodium thiosulfate – 12.5 g over 5 minutes.

Vesicants

Mustard

Lewisite

Redness and blisters.

Inhalation injury may result in respiratory distress.

Leukopenia to pancytopenia.

Topical antibiotics.

Systemic analgesics.

Fluid balance (do not overhydrate; not a thermal burn).

Bronchodilators and steroids for pulmonary symptoms, only if Lewisite is the poison, then BAL is the antidote.

Pulmonary Intoxicants

Chlorine

Phosgene

Delayed onset of non-cardiogenic pulmonary edema.

Treat hypotension with fluid; no diuretics.

Ventilate with PEEP.

Bronchodilators.

Riot Control Agents: Pepper Spray, Mace, Tear Gas

Ear, nose, mouth and eye irritation.

Irrigate.

Treat bronchospasm with bronchodilators and steroids, as needed.