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Nerve Agents

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  • 1. Nerve Agents LPC/CBRN 24 Jan 06 C191W047/1
  • 2. Introduction
    • Chemical weapons have been around for decades.
    • Nerve agents among the most deadly.
    • Manufactured by simple techniques.
    • Raw materials are inexpensive and readily available.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 3. Overview of Nerve Agents
    • Developed in Germany.
    • Only known battlefield use is in the Iran-Iraq conflict.
    • Many countries have the technology to develop nerve agents.
    • Terrorist attacks in Japan.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 4. Overview of Nerve Agents
    • Hazards in liquid and vapor state.
    • Dispersed from missiles, bombs, spray tanks, land mines, and other munitions.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 5. Overview of Nerve Agents
    • Acetylcholine (ACh) is a neurotransmitter in the nervous system.
    • Acetylcholinesterase (AChE) (an enzyme) stops the action of Ach.
    • Nerve agents bind to AChE.
    • ACh builds up and continues to act.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 6. Normal ACh Transmission Nerve to Nerve LPC/CBRN 24 Jan 06 C191W047/1 ACh
  • 7. Normal ACh Transmission Nerve to Nerve LPC/CBRN 24 Jan 06 C191W047/1 ACh
  • 8. Normal ACh Transmission Nerve to Nerve LPC/CBRN 24 Jan 06 C191W047/1 ACh
  • 9. Normal ACh Transmission Nerve to Skeletal Muscle-Stimulation LPC/CBRN 24 Jan 06 C191W047/1
  • 10. Normal ACh Transmission Nerve to Smooth Muscle-Stimulation LPC/CBRN 24 Jan 06 C191W047/1
  • 11. Normal ACh Transmission Nerve to Glands-Normal secretions LPC/CBRN 24 Jan 06 C191W047/1
  • 12. Impulse Termination: The Role of AChE LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 13. Exposure to Nerve Agent LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 14. Exposure to Nerve Agent-Binds AChE- causing excessive stimulation LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 15. Nerve Agents Effects: Skeletal Muscle-Over stimulation LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 16. Impulse Termination: The Role of AChE- Stops stimulation LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 17. Nerve Agents Effects: Smooth and Cardiac Muscle LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 18. Nerve Agents Effects on Glands- Increased Secretions LPC/CBRN 24 Jan 06 C191W047/1 ACh AChE
  • 19. Nerve Agent Characteristics
    • Liquid unless exposed to extreme heat or cold.
    • Volatility.
    • Colorless to light brown.
    • Odorless.
    • Routes of entry.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 20. Levels of Exposure and Clinical Effects
    • Depends of dosage and route of exposure.
    • Vapor effects are different than liquid effects.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 21. Level of Exposure - Mild
    • Vapor :
      • Causes effects in eyes, nose and lungs- local and/or systemic effect
    • Liquid :
      • Systemic gastrointestinal effect
    LPC/CBRN 24 Jan 06 C191W047/1
  • 22. Level of Exposure - Mild
    • Rhinorrhea - may be the first sign.
    • Frontal headache/eye pain.
    • Difficulty in seeing.
    • Tightness in chest.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 23. Level of Exposure - Mild
    • Difficulty breathing.
    • Drooling.
    • Localized sweating.
    • Muscle twitching.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 24. Level of Exposure - Severe
    • The signs and symptoms of mild nerve agent exposure may occur plus:
      • Nausea, vomiting, diarrhea
      • Severe muscle twitching
      • Seizures
      • Loss of bladder and bowel control
      • Confused behavior, followed by LOC
      • Respiratory failure > death
    LPC/CBRN 24 Jan 06 C191W047/1
  • 25. Time Interval of Effects
    • Vapor : seconds to minutes. No delay period.
    • Liquid: delay in symptoms 1-30 minutes. Small liquid exposure - symptoms up to 18 hours.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 26. Treatment Steps: Self-Aid
    • Protect yourself - put on your protective mask.
    • Give the alarm.
    • Perform a hasty self-evaluation.
    • Administer antidote if signs and symptoms are noted:
    LPC/CBRN 24 Jan 06 C191W047/1
  • 27. Treatment Steps: Self-Aid
    • Use one MARK I Nerve Agent Antidote Kit (NAAK):
    • Use one Antidote Treatment, Nerve Agent Auto-injector (ATNAA):
    LPC/CBRN 24 Jan 06 C191W047/1
  • 28. Treatment Steps: Self-Aid
    • Never administer more than one NAAK or ATNAA to yourself.
    • If you needed more than one NAAK/ ATNAA, you would be too incapacitated to know it.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 29. Treatment Steps: Self-Aid
    • Decontaminate skin if necessary.
    • Put on protective clothing (MOPP level 4).
    • Seek buddy-aid or medical care.
    LPC/CBRN 24 Jan 06 C191W047/1 JSLIST
  • 30. Mark I NAAK
    • Includes:
      • Atropine 2mg - blocks effects of acetylcholine and produces symptom relief.
      • 2-PAM-Cl 600 mg - blocks transmission of nerve agent.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 31. ATNAA
    • Includes:
      • Atropine 2.1 mg .
      • 2-PAM-Cl 600 mg .
    LPC/CBRN 24 Jan 06 C191W047/1
  • 32. Treatment Steps: Buddy-Aid
    • Protect yourself; then:
      • Mask the casualty
      • Check casualty and surrounding area for expended auto-injectors
      • Administer total of 3 MARK I NAAK/ATNAA; use the casualties’ sets.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 33. Treatment Steps: Buddy-Aid
    • Protect yourself (cont’d):
      • Administer 1 Convulsant Antidote for Nerve Agent (CANA) injector
      • Decontaminate the casualty
      • Assess effectiveness of treatment (atropinization and cessation of convulsions)
    LPC/CBRN 24 Jan 06 C191W047/1
  • 34. Treatment Steps: Buddy-Aid
    • Additional atropine can be given at 15 minute intervals until signs of nerve agent poisoning decrease:
      • Heart rate is above 90 beats per minute
      • Bronchial secretions are reduced
      • Salivation is reduced
    LPC/CBRN 24 Jan 06 C191W047/1
  • 35. Treatment Steps: Buddy-Aid
    • Additional CANA, up to a total of 3, can be given at 5 to 10 minute intervals if convulsions persist
    LPC/CBRN 24 Jan 06 C191W047/1
  • 36. CANA Injector
    • Contains diazepam (anti-seizure medication).
    • Given to all casualties requiring 3 MARK I sets.
    • Soldier medic may carry extra CANA injectors and may give additional CANA injectors in a seizing casualty.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 37. Treatment Steps: Buddy-Aid
    • Secure used injectors to the casualty’s upper left pocket flap of the BDO; left pocket on the sleeve of the JSLIST.
    • Record all treatment given on the casualty’s FMC.
    • Evacuate and provide assisted ventilations, if necessary.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 38. Side Effects of Atropine
    • Mild : dry mouth, skin flushing, drowsiness, decreased combat performance.
    • Severe : drowsiness, fatigue, visual blurring, increased heat injury risk.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 39. Medication Side Effects
    • 2-PAM-Cl :
    • Mild visual changes
    • CANA :
    • Decreased combat performance
    LPC/CBRN 24 Jan 06 C191W047/1
  • 40. Nerve Agent Pretreatment
    • 1990 (Gulf War I), US military fields pyridostigmine bromide (NAPP) as a pretreatment for nerve agent exposure.
    • NOT an antidote - not taken after exposure.
    • Mild side effects.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 41. Nerve Agent Pretreatment
    • Medication to be taken at least 8 hours prior to exposure .
    • Service members issued one NAPP in high risk areas.
    • Chain of command issues orders to start the NAPP.
    LPC/CBRN 24 Jan 06 C191W047/1
  • 42. Summary
    • Nerve Agent Characteristics
    • Signs and Symptoms of Nerve Agent Exposure
    • Treatment Steps
    • Nerve Agent Pretreatment
    LPC/CBRN 24 Jan 06 C191W047/1
  • 43. Questions? LPC/CBRN 24 Jan 06 C191W047/1