Atropine autoinjectors

If one were forced to choose between equipping ambulances with extra atropine autoinjectors in the event of a nerve agent release or instead equip these with cyanide antidote kits, which would you choose Why ... 

Atropine is the racemic mixture of l- and o-hyoscya-mine and possesses 50% of the antimuscarinic potency of L-hyoscyamine. Atropine is derived from components of the Belladonna plant and is also present in other plants from the Solanaceae family. Women in ancient times often dripped the plant s juices into their eyes, causing mydriasis and thereby enhancing their beauty. In Italian, Belladonna translates to beautiful lady . In the United States, the atropine autoinjector has been in use since 1973 for the treatment of exposures to chemical warfare nerve agents and insecticides. 

Moderate Miosis rhinorrhea moderate autoinjector, depending upon severity of dyspnea < 5 min of exposure 2x2 mg atropine autoinjectors > 5-10 min since exposure 1 or... 

Moderately severe to severe dyspnea nausea/vomiting Miosis rhinorrhea severe 2x2 mg atropine autoinjectors < 5 min of exposure 3x2 mg atropine autoinjectors 3x2 mg atropine autoinjectors ... 

Severe dyspnea nausea/vomiting fasciculations Loss of consciousness additional atropine (2 mg every 5 min) and ventilatory support may be required 5x2 mg atropine autoinjectors ... 

Moderately severe fasciculations nausea/vomiting Localized sweating autoinjectors 3x2 mg atropine autoinjectors ... 

Grasp the smaller (atropine) autoinjector with the thumb and first two fingers of your dominant hand (like holding a pen or pencil) (Figure S3.3b). 

Pull the atropine autoinjector out of the clip with a smooth motion (Figure S3.3c). Do not cover or hold the green (needle) end of the autoinjector. If you do press on the green end, you may unintentionally inject yourself. 

In 1990, the Iraqi Army invaded neighboring Kuwait. Subsequently, the United States, at the request of Saudi Arabia, led a coalition to send forces to the area (Smart, 1997). These forces were the largest to operate in a potential chemical environment since World War I. They were provided witii atropine autoinjectors, an acetylcholinesterase reactivator, and a nerve agent pretreatment (p5nidostig-mine bromide). Fortunately, chemical weapons apparently were not used in this conflict, although multiple false alarms were reported. The failure of the Iraqi military... 

Symptoms of inappropriate or unintentional use (or accidental overdosage) of atropine autoinjectors used to treat nerve agent poisoning may mimic QNB exposure. However, marked confusion from atropine is not normally seen until a total of six or seven autoinjectors have been given. 

Brand Name(s) AtroPen Autoinjector, Atropine Care, Atropisol, Atrosulf-1, Isopto Atropine, Ocu-Tropine, Sal-Tropine Cfiemical Class Belladonna alkaloid... 

Thus, treatment without the use of an oxime agent is possible. Of course, ideally, in countries where this is economically possible, treatment should use the three recommended drugs (I) atropine, (2) an oxime agent like PAM, and (3) diazepam, and the use of autoinjectors for administration is also helpfiil. Unfortunately, terrorist attacks using sarin are also carried out in less economically developed countries and even if the drugs are available, considerations related to cost performance need to be considered. In this sense, preference should be given to the availability of atropine and diazepam. In other words, unless it is economically feasible, funds should be used to obtain atropine and diazepam, rather than oxime agents, whose cost-benefit ratio is still inconclusive. 

Autoinjectors (AtroPen , Mark I , Combopen MC ) are atropine or atropine and pralidoxime combinations available for human use. They are not used in veterinary medicine as they are not adjustable for different sized patients. Experimental vaccines against nerve agent VX, and monoclonal antibodies which protect against soman, sarin, and tabun toxicity have been produced and are being tested (Dunn and Sidell, 1989 Somani et al, 1992). 

These products are provided by Meridian Medical Technologies, which has partnered with the US Department of Defense to be the only FDA-approved supplier of nerve agent antidotes. The Mark I kit and the single autoinjector devices deliver 600 mg of 2-PAM Cl and 2 mg of atropine (AtroPen ) in seconds. This kit was developed originally... 

Approximate age Approximate weight Number of Mark 1 kit autoinjectors to use Atropine dosage range (mg/kg) Pralidoxime dosage range (mg/kg)... 

The multichambered autoinjector is simply a device that will allow a nerve agent victim to administer both the atropine and the 2-PAM through a single needle. This medical device is also FDA-regulated and while each of the drugs contained in the device is approved separately, the combination delivery system requires additional FDA testing. Both of these products have spent at least a decade in development but are not expected to be fielded during the next several years. 

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