Chemical agents antidotes

Casualties with side effects from chemical agent antidotes. Some of the available antidotes may have undesirable side effects when taken inappropriately, or in large enough quantities. Atropine, for instance, causes decreased heat tolerance at a dose of 1 mg. Higher doses may cause tachycardia, dryness of the mouth, and decreased sweating. Medical personnel must be aware of the side effects of the available antidotes and be alert for their appearance. 

Treatment primarily consists of supportive care. Ventilate patient if they have difficulty breathing and administer oxygen. Be prepared to treat for shock. Monitor and support cardiac and respiratory functions as necessary. If the identity of the toxin is known, administer antidote if available. Unlike chemical agents, toxins can cause an immune response. Vaccines are available for some toxins but generally require more than 4 weeks for the body to produce antibodies. Passive immunotherapy is effective for some neurotoxins but must be instituted shortly after exposure. The utility of antibody therapy drops sharply at or shortly after the onset of the first signs of disease. 

There is no antidote for nitrogen mustard toxicity, and decontamination of potentially exposed persons must be done within minutes to avoid tissue damage. Victims should be moved out of the hot zone, administered oxygen and/or assisted ventilation, and seek medical attention at once. The nitrogen mustards are delayed chemical agents, and may delay for up to twenty-four hours to show symptoms. They are poisons, and contact with vapor or liquids can be fatal. Do not eat, drink, or smoke during response to a nitrogen mustard incident or criminal event. 

Treatment—Patients should be decontaminated immediately prior to treatment using the chemical agent decontamination method presented in Section 7.3.2. No known antidote is available. 

Antidote Antidotes are used to negate the effects of or reduce the effective intensity of poisons or other various toxins. Antidotes by their very nature are poisons themselves and can cause damage to those that overdose on them. This type of drag or chemical agent grants the user a +4 bonus on his next save against the appropriate type of poison. 

CWC-related chemicals must be handled with great care. Persons handling toxic chemicals must be specially trained for the work. When toxic samples are handled, decontamination solution, protective masks, and autoinjectors of nerve agent antidotes must always be available, and no one must ever work alone. Individual protective gear such as laboratory coats, chemically resistant protective gloves, and safety goggles are essential during sample preparation. Toxic samples must always be prepared in a fume cupboard. 

Similarly, therapeutics that detoxify the chemical agent from systemic circulation, such as protein scavengers of nerve agent or newer cobalamine-based molecules that bind and scavenge cyanide, could work as well. The Cyanide Antidote Kit has been used for several years to remove... 

We restrict our discussion here to countermeasures of nerve agents (NA), and will not discuss other chemical agents such as mustards and cyanide, and their antidotes. However, the modeling ideas outlined here can also apply to other agents. 

Even with aggressive engagement, do not rely on vaccinations or more effective chemical warfare agent antidotes to become available in the near term to midterm. 

Prehospital Setting. The most important care that the casualty receives is the care that is given within the first several minutes of a chemical attack. The conduct of the care given immediately after toxic chemical agent exposure, including the administration of antidotes, can literally mean the difference between life and death. This is not an overstatement (United States Army Medical Research Institute of Chemical Defense, June 2001). Since this care will be rendered in a warm zone, personal protective equipment (PPE) must be employed by the responder. 

Application of well-known chemical agents in terrorist acts as complex compositions with other compounds may significantly to hamper their identification in the air and on the ground with use of usual analytical methods. In this case we can expect that clinical course of intoxication of victims will be atypical and curing effect of known antidotes and other medications will be brought to nothing. Practical confirmation of such application of chemical agent in terrorist purposes with use of sarin took place in Japan (Matsumoto, 1994 Tokyo Subway, 1995). 

Briggs, C., and Simons, K., Personal protection against chemical agent development of antidotal treatment for organophosphorus poisoning, Arch. Belg. Med. Soc., 20,260-273,1984. 

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