Pre-Hospital Antidote Management

When Military Mark I Kits are not available


Patient Age
Mild Symptoms
Severe Symptoms
      • 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

2-PAM Cl: 15 mg/kg IM

Atropine: 0.1 mg/kg IM

2-PAM Cl: 25 mg/kg IM

Children: 2-10 years old

Atropine:1 mg/kg IM

2-PAM Cl: 15 mg/kg IM

Atropine: 2 mg/kg IM

2-PAM Cl: 25 mg/kg IM

Adolescent: >10 years old

Atropine: 2 mg/kg IM

2-PAM Cl: 15 mg/kg IM

Atropine: 4 mg/kg IM

2-PAM Cl: 25 mg/kg IM

Adult

Atropine: 2 to 4 mg IM

2-PAM Cl: 600 mg IM

Atropine: 6 mg IM

2-PAM Cl: 1800 mg IM

Frail Elderly

Atropine: 1 mg IM

2-PAM Cl: 10 mg/kg IM

Atropine:2 to 4 mg IM

2-PAM Cl: 25 mg/kg IM

Alerts:

2-Pam Cl solution needs to be reconstituted from the vial containing 1 gram of desiccated 2- Cl with 3 ml of saline, D5W, or sterile water into the vial and shake well. Resulting solution is 3.3 ml of 300 mg/ml.

Assisted ventilation should be started after the administration of the antidote for severe cases of exposure.

Repeat the atropine every 5 to 10 minutes until secretions have diminished and breathing has returned to baseline.


 

 

Instant Feedback:

The antidote 2-Pam Cl solution is reconstituted from a vial of desiccated 2-Cl, combined with saline, D5W, or sterile water. The resulting solution gives a concentration of 300 mg antidote for every cc of fluid
True
False


Instant Feedback:

After exposure to a nerve agent, an 8 year old child, weighing about 75 pounds, is unconcscious, with seizures and apnea. He is on his way to the hospital. The recommended total atropine dose is:
33 mg.
95 mg.
68 mg.
80 mg

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