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Table 5.4. Nerve agent triage and dosing, continued
Apnea,
convulsions,
cardiopulmonary
arrest
Immediate:
admit,
intensive-care
status
Atropine
0.05–0.10 mg/kg IV, IM, IO
Repeat q 5–10 min as above (no
max)
Endotracheal tube: increase dose 2–
3 times, mix with 3–5 mL normal
saline and introduce via suction
catheter, flush 3–5 mL normal
saline
2-PAM
25–50 mg/kg IV, IM, as
above
Midazolam, as above
Diazepam
30 days to 5 yr old: 0.05–0.3 mg/kg,
IV, max 5 mg/dose
≥5 yr old: 0.05–0.3 mg/kg, IV, max 10
mg/dose
Repeat q 15-30 min, prn
Lorazepam IV, IM
Atropine
Autoinjector
2 mg for ≥40 kg
1 mg for ≥20 kg
0.5 mg for ≥10 kg
(0.05 mg/kg/dose)
*Monitor respiratory status and blood pressure.
Note:
2-PAM
600 mg for ≥12 kg
(50 mg/kg/dose)
Diazepam
10 mg for ≥30 kg
(0.3 mg/kg/dose)
Remember airway, breathing, circulation, decontamination/drugs. Consider oxygen, bronchodilators, nasogastric tube/drainage, ophthalmic analgesia,
mydriatics, temperature control. If prolonged impairment of consciousness, EEG (to rule out nonconvulsive status epilepticus) and imaging.
Adapted from Rotenberg JS, Newmark J. Pediatrics 2003; 112:648-58.
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