Global & Disaster Medicine

Pre-Hospital Treatment Recommendations (Autoinjector-Based) Nerve Agent Poisoning

November 21st, 2019

https://chemm.nlm.nih.gov/nerveagents/FGAMMGPrehospital.htm

Pre-Hospital Treatment Recommendations (Autoinjector-Based) Nerve Agent Poisoning

Patient Age Antidotes Additional Treatment
Mild/Moderate Symptoms Severe Symptoms
Infant
(0-2 yrs)		 Atropine 0.05 mg/kg IM or Atropine AI 0.25 mg or 0.5 mg

AND

2-PAM 15-30 mg/kg IM

 Atropine 0.1 mg/kg IM or Atropine AI 0.25 mg or 0.5 mg

AND

2-PAM 45 mg/kg IM;

AND

Midazolam 0.15 mg/kg IM

OR

Lorazepam 4 mg IM

OR

Lorazepam 0.1 mg/kg IN

OR

Diazepam 0.2-0.5 mg/kg IM

 For mild/moderate, repeat atropine (2 mg) (for child 3-7 yrs, 1 mg; for infant, 0.25-0.5 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

 

For severe, repeat atropine as above but at 2-5 minute intervals.

 

Anticonvulsant should be administered in severe cases whether seizures are apparent or not.

 

If convulsions are present, repeat benzodiazepine until convulsions resolve.

 

Assisted ventilation should be started as needed after administration of antidotes.
Child
(3-7 yrs;
13–25 kg)		 1 Atropine AI 1 mg

AND

1 2-PAM AI or 2-PAM 15-30 mg/kg IM

 1 DuoDote; OR 1 Atropine AI 2 mg

AND 1 2-PAM AI or 2-PAM 45 mg/kg IM;

AND

Midazolam 5 mg IM

OR

Lorazepam 4 mg IM OR

Lorazepam 0.1 mg/kg IN

OR

1 CANA
Child
(8-14 yrs;
26-50 kg)		 1 DuoDote; OR 1 Atropine AI 2 mg

AND

1 2-PAM AI or 2-PAM 15-30 mg/kg IM

 2 DuoDote; OR 2 Atropine AI 2 mg AND 2 2-PAM AI or 2-PAM 45 mg/kg IM;

AND

Midazolam 5 mg IM

OR

Lorazepam 4 mg IM OR

Lorazepam 0.1 mg/kg IN

OR

1 CANA
Adolescent
(>14 years)/ Adult		 1 to 2 DuoDote; OR

1 to 2 Atropine AI 2 mg

AND
1 2-PAM AI

 3 DuoDote;

AND

1 CANA

OR

Midazolam 10 mg IM

OR

Lorazepam 6 mg IM/IN
Elderly, frail 1 DuoDote 2 to 3 DuoDote; OR

1 to 2 Atropine AI 2 mg

AND

2 to 3 2-PAM AI;

AND

1 CANA

OR

Midazolam 10 mg IM

OR

Lorazepam 6 mg IM/IN

Autoinjector Products:

DuoDote = ATNAA = Mark 1 kit = Atropine 2 mg + 2-PAM 600 mg AI

Atropine AI = various doses, two different manufacturers*

2-PAM AI = 2-PAM 600 mg AI

CANA = Diazepam 10 mg AI

* Please see the following webpage for more information on FDA approved atropine AI products and current nerve agent emergency use authorization information: https://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm063809.htm

This entry was posted on Thursday, November 21st, 2019 at 5:45 pm and is filed under Novichok .
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