CBRNE - Nerve Agents, Binary: GB2, VX2: Multimedia

References

1. Marrs TC, Maynard RL, Sidell FR. Chemical Warfare Agents: Toxicology and Treatment. New York, NY: John Wiley & Sons; 1996.

2. Okumura T, Suzuki K, Fukuda A, et al. The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. Acad Emerg Med. Jun 1998;5(6):613-7. [Medline].

3. Sidell FR. Clinical considerations in nerve agent intoxications. In: Chemical Warfare Agents. San Diego, CA: Academic Press, Inc; 1992.

4. Baker MD. Antidotes for nerve agent poisoning: should we differentiate children from adults?. Curr Opin Pediatr. Apr 2007;19(2):211-5. [Medline].

5. Borbely AA, Tunod U, Hopft W. Studies on the protective action of atropine and obidoxime against sarin poisoning in mice. In: Cholinergic Mechanisms. Philadelphia, Pa: Lippincott-Raven; 1975.

6. Christensen MK, Crethull P, Crook JW, et al. Resuscitation of dogs poisoned by inhalation of the nerve gas GB. Mil Med. Dec 1956;119(6):377-86. [Medline].

7. Corvino TF, Nahata MC, Angelos MG, Tschampel MM, Morosco RS, Zerkle J. Availability, stability, and sterility of pralidoxime for mass casualty use. Ann Emerg Med. Mar 2006;47(3):272-7. [Medline].

8. Department of the Army. Binary chemical munitions program. Programmatic Environmental Impact Statement ARCSL-EIS-8101. 1981:1-7.

9. Foltin G, Tunik M, Curran J, Marshall L, Bove J, van Amerongen R. Pediatric nerve agent poisoning: medical and operational considerations for emergency medical services in a large American city. Pediatr Emerg Care. Apr 2006;22(4):239-44. [Medline].

10. Freeman G, Marzulli FN, Craig AB. The toxicity of liquid GB applied to the skin of man. MLRR;1954:217.

11. Grob D, Harvey AM. The effects and treatment of nerve gas poisoning. Am J Med. Jan 1953;14(1):52-63. [Medline].

12. Harris LW, Fleisher JH, Clark J, Cliff WJ. Dealkylation and loss of capacity for reactivation of cholinesterase inhibited by sarin. Science. Oct 21 1966;154(747):404-7. [Medline].

13. Henderson JD, Higgins RJ, Dacre JC, Wilson BW. Neurotoxicity of acute and repeated treatments of tabun, paraoxon, diisopropyl fluorophosphate and isofenphos to the hen. Toxicology. 1992;72(2):117-29. [Medline].

14. Inns RH, Leadbeater L. The efficacy of bispyridinium derivatives in the treatment of organophosphonate poisoning in the guinea-pig. J Pharm Pharmacol. Jul 1983;35(7):427-33. [Medline].

15. Keim ME, Pesik N, Twum-Danso NA. Lack of hospital preparedness for chemical terrorism in a major US city: 1996-2000. Prehospital Disaster Med. Jul-Sep 2003;18(3):193-9. [Medline].

16. Kunkel AM, O'Leary JF, Jones AH. Atropine-induced ventricular fibrillation during cyanosis caused by organophosphorous poisoning. Edgewood Arsenal Technical Report 4711. 1973.

17. Lallement G, Clarencon D, Masqueliez C, et al. Nerve agent poisoning in primates: antilethal, anti-epileptic and neuroprotective effects of GK-11. Arch Toxicol. 1998;72(2):84-92. [Medline].

18. LeBlanc FN, Benson BE, Gilg AD. A severe organophosphate poisoning requiring the use of an atropine drip. J Toxicol Clin Toxicol. 1986;24(1):69-76. [Medline].

19. Lee EC. Clinical manifestations of sarin nerve gas exposure. JAMA. Aug 6 2003;290(5):659-62. [Medline].

20. Marrs TC. The role of diazepam in the treatment of nerve agent poisoning in a civilian population. Toxicol Rev. 2004;23(3):145-57. [Medline].

21. Marrs TC. Toxicology of oximes used in treatment of organophosphate poisoning. Adverse Drug React Toxicol Rev. 1991;10(1):61-73. [Medline].

22. McDonough JH, McLeod CG, Nipwoda MT. Direct microinjection of soman or VX into the amygdala produces repetitive limbic convulsions and neuropathology. Brain Res. Dec 1 1987;435(1-2):123-37. [Medline].

23. Mitretek Systems. Binary Chemical Weapons. Noblis. Available at http://www.noblis.org/BinaryChemicalWeapons.htm.

24. Newmark J. Nerve agents: pathophysiology and treatment of poisoning. Semin Neurol. Jun 2004;24(2):185-96. [Medline].

25. Nozaki H, Aikawa N, Fujishima S, et al. A case of VX poisoning and the difference from sarin. Lancet. Sep 9 1995;346(8976):698-9. [Medline].

26. Nozaki H, Hori S, Shinozawa Y, et al. Secondary exposure of medical staff to sarin vapor in the emergency room. Intensive Care Med. Dec 1995;21(12):1032-5. [Medline].

27. Okudera H. Clinical features on nerve gas terrorism in Matsumoto. J Clin Neurosci. Jan 2002;9(1):17-21. [Medline].

28. Parker RM, Crowell JA, Bucci TJ. Negative delayed neuropathy study in chickens after treatment with isopropyl methylphosphonofluoridate (sarin, type 1). Toxicol. 1988;8:248.

29. Rickett DL, Glenn JF, Beers ET. Central respiratory effects versus neuromuscular actions of nerve agents. Neurotoxicology. 1986;7(1):225-36. [Medline].

30. Robineau P, Guittin P. Effects of an organophosphorous compound on cardiac rhythm and haemodynamics in anaesthetized and conscious beagle dogs. Toxicol Lett. Jun 1987;37(1):95-102. [Medline].

31. Rotenberg JS. Diagnosis and management of nerve agent exposure. Pediatr Ann. Apr 2003;32(4):242-50. [Medline].

32. Schier JG, Ravikumar PR, Nelson LS. Preparing for chemical terrorism: stability of injectable atropine sulfate. Acad Emerg Med. Apr 2004;11(4):329-34. [Medline].

33. Secretariat of the Organisation for the Prohibition of Chemical Weapons. Nerve Agents. ICA Division, OPCW. Organisation for the Prohibition of Chemical Weapons. Available at http://www.opcw.org/.

34. Sidell FR. Nerve agents. In: Textbook of Military Medicine. Washington, DC: TMM Publications; 1997.

35. Sidell FR, Groff WA. The reactivatibility of cholinesterase inhibited by VX and sarin in man. Toxicol Appl Pharmacol. Feb 1974;27(2):241-52. [Medline].

36. Sim VM. Variability of different intact human skin sites to the penetration of VX. CRDL Report 3122. 1962.

37. Sim VM, Stubbs JL. VX percutaneous studies in man. CRDL Report 3015. 1960.

38. Smart JK. History of Chemical and Biological Warfare Fact Sheets. 1996.

39. Somani SM, Solana RP, Dube SN. Toxicodynamics of nerve agents. In: Chemical Warfare Agents. San Diego, CA: Academic Press Inc; 1992.

40. Thiermann H, Szinicz L, Eyer P, Felgenhauer N, Zilker T, Worek F. Lessons to be learnt from organophosphorus pesticide poisoning for the treatment of nerve agent poisoning. Toxicology. Apr 20 2007;233(1-3):145-54. [Medline].

41. Tokuda Y, Kikuchi M, Takahashi O, Stein GH. Prehospital management of sarin nerve gas terrorism in urban settings: 10 years of progress after the Tokyo subway sarin attack. Resuscitation. Feb 2006;68(2):193-202. [Medline].

42. Ward FP. Construction and Operation of a 155-mm M687 GB2 Binary Production Facility at Pine Buff Arsenal, Jefferson County, Arkansas. Environmental Assessment ARCSL-EA-8101. 1981:3-7.

43. Wills JH, DeArmon IA. A statistical study of the Adamek report. Medical Laboratory Special Report 54. AD045106.

44. Worek F, Eyer P, Aurbek N, Szinicz L, Thiermann H. Recent advances in evaluation of oxime efficacy in nerve agent poisoning by in vitro analysis. Toxicol Appl Pharmacol. Mar 2007;219(2-3):226-34. [Medline].

45. Wright PG. An analysis of the central and peripheral components of respiratory failure produced by anticholinesterase poisoning in the rabbit. J Physiol. Oct 28 1954;126(1):52-70. [Medline].

46. Young D. CDC rolls out nerve-agent antidote program. Am J Health Syst Pharm. Sep 15 2004;61(18):1866-8, 1875. [Medline].

Further Reading

For a discussion about Novichok agents, see Chemical Weapons Disarmament in Russia: Problems and Prospects.

Keywords

nerve agents, binary agents, GB2, VX2, sarin, chemical warfare, acetylcholinesterase inhibitors, AChE inhibitors, GA, tabun, GD, soman, chemical weapons, GB, VX, GD2, acetylcholine, cholinergic overstimulation, organophosphate, carbamate, pralidoxime chloride, Protopam, 2-PAM, anticholinergics, oximes, AChE reactivator, muscarinic receptor

Contributor Information and Disclosures

Author

Larissa I Velez-Daubon, MD, Associate Professor, Associate Program Director, Department of Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical School, Parkland Memorial Hospital; Associate Program Director and Staff Toxicologist, Department of Surgery, Division of Emergency Medicine, North Texas Poison Center, Parkland Memorial Hospital
Larissa I Velez-Daubon, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Fernando L Benitez, MD, Assistant Medical Director, Dallas Metropolitan BioTel (EMS) System; Associate Professor in Emergency Medicine, Department of Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center and Parkland Health and Hospital
Fernando L Benitez, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and National Association of EMS Physicians
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Daniel C Keyes, MD, MPH, Director of Terrorism Response Education, John Peter Smith Hospital; Clinical Associate Professor, Department of Surgery, Division of Emergency Medicine and Toxicology, University of Texas Southwestern School of Medicine
Daniel C Keyes, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, and American College of Physicians-American Society of Internal Medicine
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