A Review Article on Nerve Agents

Abstract

The incidence of Tokyo subway attack by the Aum Shinrikyo cult in 1995 had raised the concern of the use of nerve agent as a weapon in terrorist attack. The recent event in World Trade Centre in New York city had further brought our attention to the possibility of terrorist attacks using these agents. In view of the high possibility of nerve agents being used as chemical weapon, medical personnel should have a clear knowledge of these agents. This article aim to provide a detailed discussion of these agents.

Advances in toxicology and medical treatment of chemical warfare nerve agents

“…MARK I kit, which is the most popular one, is composed of 2 mg atropine (0.7 ml) and 600 mg 2-pyridine aldoxime methyl chloride (2-PAMCl) [105]. The ATNAA, designated by the Department of Defense of U.S., contains 2.1 mg/0.7 mL atropine and 600 mg/2 mL 2-PAM, and has ability of simultaneously injection both of them through single needle [102,106].…”

“…Every soldier carries 3 kits and one auto-injector containing 10 mg diazepam when there is a suspicious of NA attack [105]. …”

“…The second one should be added depends on the severity of respiratory distress. Applying three MARK I kits and diazepam is necessary when severe breathing difficulty or apnea, cyanosis, muscle fasciculation or twitching, seizure or loss of consciousness are present [105,107-110]. …”

“…Contaminated skin or clothing of victims can contaminate others by close contact or through off-gassing vapor [110]. Thus, decontamination should be performed as soon as possible to reduce skin absorption of NAs and prevention of the rescuers contamination, members of medical team and other patients [1,105]. This is the beat that all casualties before transport are decontaminated [110].…”

“…Medical and paramedical personnel who manage and assist to casualties either in the field, during transportation or in the hospital, must protect themselves from NAs contamination [105]. Eight staff who had taken apart in Matsumoto incident had mild symptoms of sarin poisoning [112].…”