Response, Treatment and Prevention

Medical response, treatment and prevention (prophylaxis) to nerve agent exposure are ever expanding fields of research [6,12,13]. Atropine, which rapidly reverses cholinergic over expression at synapse junctions, is the most commonly used anticholinergic. Mark I kits, which contain 2 mg atropine with an autoinjector for intramuscular use, are issued to US military personnel [2]. Recommended initial field doses for atropine are 2, 4 or 6 mg with re-treatment every 5-10 min depending on the symptoms. In addition, oximes reactivate cholinesterase enzymes, ensuring normal function. Mark I kits also include 600 mg autoinjectors of 2-pralidoxime chloride (2-PAM Cl) with initial field doses of 600, 1200 or 

1800 mg [2]. Benzodiazepine is utilized to counteract seizures associated with nerve agent exposure. Typically administered in 10 mg autoinjector doses, midazolam or diazepam are approved for field use. 

Prophylaxis (pre-treatment) is defined as the implementation of medical countermeasures prior to exposure of an organism to a nerve agent [6]. These countermeasures fall into two main categories protection against AChE 

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