CME Information

Editorial Board

Lessons by Volume

Chemical Terrorism

By James A. Geiling, MD, FCCP

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**Table 9—**Summary of Recommendations*
Exposure Route	Exposure Category	Signs and Symptoms	Therapy
Inhalational (vapor)	Minimal	Miosis with or without rhinorrhea; reflex nausea and vomiting	< 5 min of exposure: one MARK I kit > 5 min of exposure†: observation
	Mild	Miosis; rhinorrhea; mild dyspnea; reflex nausea and vomiting	< 5 min of exposure: two MARK I kits > 5 min of exposure: zero or one MARK I kit, depending on severity of dyspnea
	Moderate	Miosis; rhinorrhea; moderate to severe dyspnea; reflex nausea and vomiting	< 5 min of exposure: three MARK I kits + diazepam > 5 min of exposure: one to two MARK I kits
	Moderately severe	Severe dyspnea; GI or neuromuscular signs	Three MARK I kits; standby ventilatory support; diazepam
	Severe	Loss of consciousness; convulsions; flaccid paralysis; apnea	Three MARK I kits; ventilatory support; suction; diazepam
Dermal (liquid on skin)	Mild	Localized sweating; fasciculations	One MARK I kit
	Moderate	GI signs and symptoms	One MARK I kit
	Moderately severe	GI signs plus respiratory or neuromuscular signs	Three MARK I kits; standby ventilatory support
	Severe	Same as for severe vapor exposure	Three MARK I kits; ventilatory support; suction; diazepam
*From Sidel.¹³
†Casualty has been out of contaminated environment during this time.

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