CBRNE - Nerve Agents, G-series - Tabun, Sarin, Soman Follow-up

Updated: Jan 05, 2016
  • Author: Kermit D Huebner, MD, FACEP; Chief Editor: Duane C Caneva, MD, MSc  more...
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Follow-up

Further Outpatient Care

Toxic effects of GB usually peak within minutes to hours and resolve within 24 hours. Thus, patients who inhale nerve agent vapor suffer peak toxic effects before arriving in the ED. Patients who present to the ED with only ocular findings following vapor exposure can be discharged home safely. Refer patients discharged home with miosis or other eye complaints to an ophthalmologist.

Onset of signs and symptoms in patients with dermal exposure to liquid GB may be delayed for as long as 18 hours. Observe these patients in the ED or hospital for at least 18 hours. As discussed in Workup, RBC or plasma cholinesterase activity alone should never determine disposition and must always be correlated with the patient's clinical status.

A variety of neurobehavioral symptoms may persist in patients exposed to nerve agents. Such patients may benefit from neurologic consultation.

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Further Inpatient Care

Severely poisoned patients in respiratory arrest may need ventilatory assistance for several hours despite aggressive antidotal therapy. Patients in critical condition caused by complications of nerve agent poisoning, such as hypoxic brain injury, may require prolonged intensive care.

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Transfer

Transfer patients only after performing appropriate decontamination and appropriately addressing the need for an airway and ventilation.

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Complications

Few data are available describing long-term effects of nerve agent exposure. The following has been reported:

  • Structural brain damage in animals has been attributed to nerve agent–induced seizures. A consensus panel of experts concluded that structural brain damage does not occur until seizures have lasted longer than 45 minutes. [17]
  • Miosis-related visual problems in dim light and mental lapses have been reported as long as 6-8 months after nerve agent exposure.
  • In long-term studies of victims of the Tokyo subway GB attack, postural imbalance has been reported 8 months after exposure to GB. [18] Fatigue, asthenia, nausea, shoulder stiffness, and blurred vision have been reported 3 years after exposure to GB. [19]
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Prognosis

Patients who survive nerve agent exposure have a good prognosis. A study by Chao et al examined long-term effects of sarin exposure on brain function in 40 soldiers with suspected exposure. [20] No cognitive effects were noted.

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Patient Education

See the list below:

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