1. NERVE AGENT EXPOSURE
CA128

2. OBJECTIVE
Identify the specific signs and symptoms of nerve agent exposure
CA129

3. HOW NERVE AGENTS WORK Attack nervous system
nervous system controls body functions through use of chemicals which act as “instructions” to nerves, muscles and glands
Nerve agents interfere with normal chemical instructions
Nerve synapse
CA130

4. NORMAL NERVOUS SYSTEM At nerve ending, acetylcholine is released
Acetylcholine crosses synapse between nerve endings
if junction with skeletal muscle, muscles cells contract
if junction with smooth muscles, muscles move rhythmically
if junction with gland, glandular cells secrete
Acetylcholine is inactivated by acetylcholinesterase
Normal activity at nerve synapse
CA131

5. HOW NERVE AGENTS WORK
Nerve agents block acetylcholinesterase so it cannot destroy acetylcholine
acetylcholine accumulates and continue to stimulate target nerve
muscles twitch uncontrollably and repetitively
excess secretions of glands
Nerve agent interferes with normal synapse activity
CA132

6. ROUTES OF EXPOSURE
Direct Contact
Inhalation
Ingestion
CA133

7. INHALATION Nerve agents enter through respiratory system
Rapidly and effectively enter into blood stream
Respiratory failure
chief cause of death
after severe exposure
Nerve agent inhaled into respiratory system
CA134

8. DIRECT CONTACT Skin or eyes are touched with agent vapor or liquid
Nerve agents absorbed through skin
VX remains on skin and absorbed more completely
GB evaporates quickly, but still a threat
Scrapes, cuts or other skin damage offer direct entry points
freshly shaven skin, sunburn, insect bites, rashes
Eyes most sensitive organ for nerve agent vapor effects
CA135

9. INGESTION
Ingestion of contaminated food or drink, incidental hand to mouth or eye contact, smoking
Unlikely that agent will contaminate food or drink
Gastrointestinal system
CA136

10. SIGNS AND SYMPTOMS Not all signs and symptoms may appear . . .
Signs are objective evidence of a medical condition
Signs are observed (runny nose, drooling)
Symptoms are subjective evidence
Symptoms are verbally communicated (headache, eye pain)
Not all signs and symptoms may appear . . .
Dose, duration, and route of exposure make a difference
CA137

11. SIGNS AND SYMPTOMS OF NERVE AGENT EXPOSURE
Miosis
Dim or blurred vision
Respiratory trouble
Difficulty in breathing
Increased oral/nasal secretions
Localized sweating
Nausea and vomiting
Abdominal cramping
Involuntary urination or bowel movements
Heartbeat irregularities
Generalized weakness
Twitching or muscles spasms
Convulsions and coma
CA138

12. OTHER SIGNS AND SYMPTOMS OF NERVE AGENT EXPOSURE
May result from early or mild exposure:
headache
anxiety
restlessness
giddiness
irritability
CA139

13. FACTORS AFFECTING NERVE AGENT SIGNS AND SYMPTOMS
Signs and symptoms may appear immediately or be delayed
Reaction time depends on
type of agent
amount of agent person has been exposed to
dose (how much a person has absorbed)
duration of exposure
route of exposure
sensitivity of person’s system
CA140

14. FACTORS AFFECTING NERVE AGENT SIGNS AND SYMPTOMS
Immediate if moderate to large amounts are inhaled if moderate to large amounts are spilled onto the skin
Delayed if small amounts are involved if agent has been absorbed through skin in small localized area
CA141

15. INHALATION PEAK EFFECTS FROM NERVE AGENT
Effects can occur after single breath
Immediate response within seconds
Peak effects usually within minutes
After about 20 minutes, effects usually maximized and will not worsen
Respiratory system
CA142

16. DIRECT CONTACT PEAK EFFECTS FROM NERVE AGENT
Absorption may continue for hours even after decontamination
Effects may not occur for 1 to 18 hours
effects usually not lethal
CA143

17. OTHER POSSIBLE CAUSES Signs and symptoms may also be caused by
epilepsy
gastroenteritis
exposure to agricultural insecticides
emphysema
strokes
head trauma
drug overdose
heat illnesses
allergies
upper respiratory illnesses
CA144

18. INITIAL FIRST AID TREATMENT
Immediate removal from source of exposure
severity directly proportional to absorbed dose
Decontamination
preferred decontamination solution is undiluted household bleach
Antidote administration with airway management support as necessary
Must be provided by properly trained and equipped personnel
CA145

19. NERVE AGENT ANTIDOTE Atropine 2-PAM Chloride
administered to block receptor sites of acetylcholine
2-PAM Chloride
restores acetylcholinesterase
Two-part nerve agent antidote
CA146