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Table 5.4. Nerve agent triage and dosing
Symptoms Triage level:
Anticholinergics
Asymptomatic
Miosis, mild
rhinnorhea
Miosis and any
other symptom
disposition
Delayed:
observe
Delayed: admit
or observe
Immediate:
admit
Oxime-pralidoxime
chloride (2-PAM)
Benzodiazepines*
None None None
None None None
Atropine
0.05 mg/kg IV, IM, IO, to max 4
mg; repeat as needed q 5–10 min
until pulmonary resistance improves
or secretions resolve; correct
hypoxia before IV use; increased
risk of ventricular fibrillation
Alternatives:
Consider scopolamine for nervous
system and peripheral effects;
glycopyrrolate for peripheral effects
only
2-PAM
25–50 mg/kg IV, IM, to
max 1,800 mg; repeat q 1
hr prn; watch for muscle
rigidity, laryngospasm,
tachycardia, hypertension
If neurologic symptoms or rapid
progression:
Midazolam
0.15–0.2 mg/kg, IM, IV, repeat as
necessary or start continuous IV drip;
less likely to cause apnea by IM route
Diazepam IV, prn (see below)
Lorazepam
IV at 0.05–0.1 mg/kg (IM absorption
variable)
If IV or IM is not available, consider
midazolam given sublingual or
intranasal at 0.2 mg/kg or diazepam
prn or lorazepam prn
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