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Agent 15 Poisoning Treatment & Management

  • Author: Geoffrey M Fitzgerald, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
 
Updated: Apr 10, 2015
 

Prehospital Care

See the list below:

  • Protection of medical personnel includes removing weapons from victims and using restraints as necessary.
  • Use chemical protective masks if residual aerosolized BZ or Agent 15 is present. The high-efficiency particulate air (HEPA) filter in the gas mask provides adequate protection.
  • Protective gowns and gloves are indicated.
  • Decontamination of victims is critical and involves removing contaminated clothing and flushing the skin with soap and water. Fine particles can be brushed away gently.
  • Anticholinergic poisoning places the victim at high risk for hyperthermia. Thus, remove heavy clothing and initiate intravenous fluids as indicated.
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Emergency Department Care

See the list below:

  • Ensuring that appropriate decontamination has occurred is paramount to stabilize the patient and to prevent facility contamination. Complete decontamination of the skin and clothing if not already performed in the prehospital setting. Any residual Agent 15 on skin or clothing can be removed effectively with soap and water.
  • The 2 greatest risks to the patient are his or her own erratic behavior and hyperthermia.
    • Confiscate weapons and closely observe the patient. Physical restraints may be needed in severely affected patients.
    • Monitor core temperature and maintain adequate fluids orally or intravenously.
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Consultations

Additional advice can be acquired by calling the US Army Medical Research Institute of Chemical Defense at the Aberdeen Proving Grounds, Maryland, at (410) 436-3628.

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Contributor Information and Disclosures
Author

Geoffrey M Fitzgerald, MD Consulting Staff, Concord Emergency Medical Associates

Disclosure: Nothing to disclose.

Coauthor(s)

David P Sole, DO Associate, Department of Emergency Medicine, Faculty, Emergency Medicine Residency Program, Geisinger Medical Center; Clinical Assistant Professor (Adjunct) of Emergency Medicine, Temple University School of Medicine

David P Sole, DO is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Duane C Caneva, MD, MSc Senior Medical Advisor to Customs and Border Protection, Department of Homeland Security (DHS) Office of Health Affairs; Federal Co-Chair, Health, Medical, Responder Safety Subgroup, Interagency Board (IAB)

Disclosure: Nothing to disclose.

Additional Contributors

Suzanne White, MD Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, Michigan State Medical Society

Disclosure: Nothing to disclose.

References
  1. Goldfrank L, Flomenbaum N, Lewin N, et al. Anticholinergic poisoning. J Toxicol Clin Toxicol. 1982 Mar. 19(1):17-25. [Medline].

  2. Bowen TE. Emergency War Surgery. Revisionist Press; 1988. 93-94.

  3. Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000 Apr. 35(4):374-81. [Medline].

  4. Goldfrank LR, Flomenbaum NE. Goldfrank's Toxicologic Emergencies. Appleton & Lange; 1998.

  5. Ketchum JS, Sidell FR. Incapacitating agents. Textbook of Military Medicine, Warfare, Weaponry and the Casualty: Medical Aspects of Chemical and Biological Warfare. United States Government Printing Office; 1997. 287-306.

  6. Schneir AB, Offerman SR, Ly BT, Davis JM, Baldwin RT, Williams SR, et al. Complications of diagnostic physostigmine administration to emergency department patients. Ann Emerg Med. 2003 Jul. 42(1):14-9. [Medline].

  7. Shannon M. Toxicology reviews: physostigmine. Pediatr Emerg Care. 1998 Jun. 14(3):224-6. [Medline].

  8. Tintinalli JE. Anticholinergic toxicity. Emergency Medicine: A Comprehensive Study Guide. McGraw Hill; 2000. 1182-1185.

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