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Introduction

  • Used as pesticides
  • Used as weapons (nerve agents)
    • Sarin Gas, VX Gas, Novichok
  • Transdermal, Inhalation, Ingestion

Clinical Presentation

  • Muscarinic Activation (Dumbels Mnemonic)
    • Defication
    • Urination
    • Myosis
    • Bradycardia, Bronchospasm, and Bronchorrhea
      • “The Killer B’s”
    • Emesis
    • Lacrimation
    • Salivation and Sweating
  • Nicotinic Activation
    • Muscle weakness and paralysis
  • CNS Activation
    • Respiratory Depression
    • Altered Mental Status
    • Seizures

Treatment

  • Atropine
    • Reverses Dumbels
    • Keep giving and doubling the dose until brochorrhea and bradycardia resolve
  • Pralidoxime
    • Only works before ‘aging’ occurs
  • Diazepam
    • Stops the seizures