Nerve Agents

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Nerve Agents

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