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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 10/2017

01.08.2017 | Review Article/Brief Review

A primer on nerve agents: what the emergency responder, anesthesiologist, and intensivist needs to know

verfasst von: Keith Candiotti, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 10/2017

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Abstract

Purpose

The purpose of this review article is to familiarize first responders, anesthesiologists, and intensivists with the medical management of patients exposed to nerve agents.

Source

This review is based on the current medical literature available to the general medical community.

Principal findings

Nerve agents are some of the deadliest substances known to humanity. Though they kill primarily via muscle paralysis, which leads to respiratory arrest, these agents affect virtually every organ system in the body. Their primary mechanism of action is the body-wide inhibition of cholinesterases. This inhibition leads to the accumulation of acetylcholine, stimulating both nicotinic and muscarinic receptors. After decontamination, the primary treatment is with atropine to control muscarinic symptoms and with oximes to reactivate the cholinesterases and treat the nicotinic symptoms. Atropine doses can be much higher than conventionally used. Seizures are generally best treated with benzodiazepines. Patients with substantial exposure may require ventilatory and intensive care unit support for prolonged periods of time.

Conclusion

While it is unlikely that most medical practitioners will ever encounter nerve agent poisoning, it is critical to be aware of the presenting symptoms and how best to treat patients exposed to these deadly agents. History has shown that rapid medical treatment can easily mean the difference between life and death for a patient in this situation.
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Metadaten
Titel
A primer on nerve agents: what the emergency responder, anesthesiologist, and intensivist needs to know
verfasst von
Keith Candiotti, MD
Publikationsdatum
01.08.2017
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 10/2017
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-017-0920-2

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