Nerve Agent Intoxication Prevention

Nerve agent intoxication requires rapid decontamination to prevent further absorption by the patient and to prevent exposure to others ventilation when necessary, as well as... 

Nerve agent intoxication requires rapid decontamination to prevent further absorption by the patient and to prevent exposure to others, ventilation when necessary, administration of antidotes, as well as supportive therapy. Skin decontamination is not necessary with exposure to vapor alone, but clothing should be removed to get rid of any trapped vapor. With nerve agents, there can be high airway resistance due to bronchoconstric-tion and secretions, and initial ventilation is often difficult. The restriction will decrease with atropine administration. Copious secretions which maybe thickened by atropine also impede ventilatory actions and will require frequent suctioning. For inhalation exposure to nerve agents, ventilation support is essential. 

The principles of care for a casualty with nerve agent intoxication include termination of exposure, maintenance of ventilation, administration of antidotes, and supportive therapy. For successful medical management, early and intense therapy after severe exposure to nerve agents is necessary to prevent death. The condition of the patient will dictate the need for specific treatment procedures and the order of administration. It is of utmost importance that medical care providers are protected from contamination by use of appropriate protective clothing, otherwise they may become additional casualties. ... 

The reversibility of inhibition is very important for carbamates. They react with AChE in the same manner, forming a carbamylated (inactive) enzyme, preventing phosphylation of the carbamylated portion of the enzyme however, spontaneous decarbamylation occurs very quickly and the released enzyme serves as a normal enzyme source, provided that no inhibitory concentration of an AChE inhibitor is present anymore. Therefore, reversible inhibitors (mostly carbamates) are used as prophylactics against OP/nerve agents intoxications. 

Gupta, R.D., Goldsmith, M., Ashani, Y., et al., 2011. Directed evolution of hydrolases for prevention of G-type nerve agent intoxication. Nat. Chem. Biol. 7 (2), 120-125. 

The Centers for Disease Control and Prevention (CDC) has not published a specific case definition for intoxication by carbamates. However, the case definition for nerve agents and organophosphates states... 

---