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Lessons by Volume

Chemical Terrorism

By James A. Geiling, MD, FCCP

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**Table 5—**Nerve Agents*
Signs and Symptoms
Vapor
Small exposure: miosis, rhinorrhea, mild difficulty breathing Large exposure: sudden loss of consciousness, convulsions, apnea, flaccid paralysis, copious secretions, miosis
Liquid on skin
Small to moderate amount: localized sweating, nausea, vomiting, feeling of weakness Large amount: sudden loss of consciousness, convulsions, apnea, flaccid paralysis, copious secretions
Detection
M256A1, CAM, M8 paper, M9 paper, M8A1 and M8 alarm systems
Decontamination
M291, M258A1, hypochlorite, large amounts of water
Immediate Management
Administration of MARK I Kits (atropine and pralidoxime chloride) Diazepam in addition if casualty is severe Ventilation and suction of airways for respiratory distress
From the Medical Management of Chemical Casualties Handbook*.⁶

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