Examples: sarin, cyclsarin, soman, tabun, VX
Mechanism of action for a nerve agent: stimulation of muscarinic and nicotinic cholinergic receptors
Clinical findings:
(1) SLUDGE (salivation, lacrimation, urination, diarrhea, gastrointestinal cramps, emesis)
(2) bradycardia (tachycardia early)
(2) bronchospasm and wheezing
(3) bronchorrhea (excessive respiratory secretions) and rhinorrhea
(4) weakness
(5) fasciculations and/or tremors
(6) foaming at the mouth
(7) pinpoint pupils
(8) altered mental status or coma
(9) slurred speech
(10) ataxia
(11) seizures
(12) cyanosis
Significant factors impacting ED care:
(1) Multiple casualties may present in a mass terrorist attack.
(2) Victims may have contaminated clothing or skin, with possible secondary exposure of first responders and unprotected ED personnel.
(3) The exposure may be confused with other intoxications.
(4) There is a need to immediately report a case to public health authorities.
Antidotes:
(1) atropine (blocks acetylcholine receptors)
(2) pralidoxime (prevents acetylcholinesterase deactivation)
(3) benzodiazepine (to control seizures and fasciculations)
