CBRNE - Nerve Agents, Binary - GB2, VX2 Follow-up

Updated: Dec 18, 2018
  • Author: Larissa I Velez-Daubon, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
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Follow-up

Further Outpatient Care

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  • Patients who are discharged from the hospital do not usually require further instructions or care. Nerve agents have not been associated with organophosphate-induced delayed neuropathy. Advise patients with miosis not to drive at night until their visual deficit resolves, which may take several weeks.

  • Posttraumatic stress disorder is common after terrorist events; patients may need a psychiatric evaluation or referral.

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Further Inpatient Care

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  • Admit all patients with liquid exposures for observation, even if initially asymptomatic. Onset of symptoms with these exposures may be delayed as long as 18 hours.

  • After a vapor exposure with only minimal symptoms, the patient can usually be discharged home.

  • Admit patients who have more than simple miosis for observation and further inpatient care.

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Inpatient & Outpatient Medications

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  • The cornerstone of management is the early use of antidotes (atropine and pralidoxime). No evidence supports the use of long-term therapy after the acute phase is over.

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Transfer

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  • Prompt delivery of antidotes is of foremost importance in these patients. Transfer to a higher level of care facility may be arranged after decontamination, antidote administration, and stabilization of the patient.

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Complications

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  • Patients with status epilepticus or hypoxemia may experience anoxic brain injury.

  • Delayed or insufficient use of pralidoxime can lead to protracted muscle weakness.

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Prognosis

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  • If patients recover from the acute effects of the exposure, chronic effects are generally not expected. Subtle behavioral and cognitive changes have been noted to persist for days to weeks after the initial exposure. Patients may have permanent sequelae if they experienced anoxia during the acute phase of the poisoning.

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Patient Education

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