Nursing Continuing Education

Emergency Department Antidote Management

Patient Age	Mild Symptoms	Severe Symptoms
Patient Age	Localized sweating Difficulty breathing Nausea, vomiting, diarrhea Muscle fasciculation, weakness	Apnea Seizures Flaccid paralysis Unconsciousness
Infant:: <2 years old	Atropine: 0.05 mg/kg IM or 0.02 mg/kg IV 2-PAM Cl: 15 mg/kg IV slowly	Atropine: 0.1 mg/kg IM or 0.02 mg/kg IV 2-PAM Cl: 15 mg/kg IV slowly
Children: 2-10 years old	Atropine: 1 mg IM 2-PAM Cl: 15 mg/kg IV slowly	Atropine: 2 mg/kg IM 2-PAM Cl: 15 mg/kg IV slowly
Adolescent: >10 years old	Atropine:2 mg IM 2-PAM Cl: 15 mg/kg IV slowly	Atropine: 4 mg/kg IM 2-PAM Cl: 15 mg/kg IV slowly
Adult	Atropine: 2 to 4 IM 2-PAM Cl: 15 mg/kg (1 g) IV slowly	Atropine: 6 mg IM 2-PAM Cl: 15 mg/kg (1 g) IV slowly
Frail Elderly	Atropine: 1 mg IM 2-PAM Cl: 5 - 10 mg/kg IV slowly	Atropine: 2 mg IM 2-PAM Cl: 5 - 10 mg/kg IV slowly

Alerts:

2-Pam Cl solution may need to be reconstituted from the vial containing 1 gram of desiccated 2- Cl with 3 ml of saline, 5% distilled water, or sterile water into the vial and shake well. Resulting solution is 3.3 ml of 300 mg/ml.
Use Phentolamine for hypertension induced by 2-PAM (5 mg IV for adults, 1 mg IV for children).
Use diazepam for seizure control (0.2 - 0.5 mg IV <5 yo; 1 mg IV for children > 5 yo; 5 mg for adults).
Repeat atropine every 5 to 10 minutes until secretions have diminished and dyspnea relieved (for infants, use 2 mg IM or 1 mg IV)

Instant Feedback:

After exposure to a nerve agent, an 160 pound adult, is sweating, having some difficulty breathing, and is nauseated and vomiting. He has not been treated on the way to the hospital, but is now in the Emergency Room. The recommended dose, given slow IV, of 2-PAM Cl is:

110 mg
1.095 Grams
5.28 grams
528 mg.

The American College of Physicians (ACP) and the American Society of Internal Medicine (ASIM) have online volumes of information to support this course. They also have self-assessment questions, where a short case study is presented, a question is posed, and feedback is given.

Don't Miss This Feature.

Their home page for the Bioterrorism comprehensive information is available at this link.

The Self-Assessment questions are at this link. (don't miss question #2!)