Nursing Continuing Education

Pre-Hospital Antidote Management

When Military Mark I Kits are not available

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 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

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