Learning Objectives
Identify major nerve agents (Sarin, VX) and their properties
Understand mechanism of organophosphate toxicity
Recognize cholinergic toxidrome using SLUDGEM mnemonic
Implement decontamination and antidote administration
Nerve Agent Overview
Video: Nerve Agent Exposure & Treatment
Mechanism: Inhibit acetylcholinesterase → Accumulation of acetylcholine → Cholinergic crisis
Sarin (GB)
Volatile liquid, easily inhaled as vapor. Rapid onset within seconds to minutes.
VX
Oily, persistent liquid absorbed through skin. Slower onset but more lethal.
SLUDGEM - Cholinergic Toxidrome
SLUDGEM Mnemonic
Salivation
Lacrimation
Urination
Defecation
GI Upset
Emesis
MIOSIS (Pinpoint Pupils)
MOST RELIABLE EARLY SIGN
CLINICAL PEARL
MIOSIS (pinpoint pupils) is the most reliable early sign of nerve agent exposure
Treatment Protocol
IMMEDIATE ACTIONS
- 1DECONTAMINATE - Remove all clothing, wash with water
- 2Protect airway - Suction secretions, prepare for intubation
- 3Administer antidotes IMMEDIATELY
Atropine
Blocks muscarinic effects (dries secretions, reverses bronchospasm)
- • Initial: 2-6 mg IV
- • Repeat every 5-10 minutes
- • May need 100+ mg in severe cases
Pralidoxime (2-PAM)
Reactivates acetylcholinesterase
- • Must be given early (before "aging")
- • 1-2 grams IV over 15-30 minutes
- • Diazepam for seizure control
CRITICAL SAFETY WARNING
- • Contaminated patients can OFF-GAS toxic vapors
- • Standard hospital PPE is INADEQUATE
- • Requires chemical-resistant suit and respirator
- • Decontamination MUST occur BEFORE patient enters ED
Key Takeaways
Nerve agents inhibit acetylcholinesterase → cholinergic crisis
MIOSIS (pinpoint pupils) is the most reliable early sign
SLUDGEM: Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, Miosis
Antidotes: Atropine + Pralidoxime