Authors

  • Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Comments

Anon

Members of the military have auto-injectors for diazepam or midazolam, as well as the standar atropine/2-PAM injector pack. Midazolam is being worked in as the replacement for diazepam. Servicemen and women in areas where risk of exposure is considered high are also maintained on a prophylactic dose of pyridostigmine bromide, so that the 2-PAM has sites to work upon.

Though it's been two years since I worked as a civilian researcher for the US Army, I believe SOP remains that any non-medical member is allowed to administer up to 2 anticonvulsant doses, 2 2-PAMs, and as many atropine injectors as they can find in case of suspected nerve agent exposure.

mkeamy

Thank you for your comment. I suspect that the military has more extensive experience on the outcomes and likely dosing requirements for nerve agent exposures. I am intrigued that pyridostigmine pretreatment is helpful, but I know from other contexts that they wouldn't do it if they didn't have data suggesting it works. I recall twenty+ years ago a study where half of combatants were given decadron and half were not pre-combat, in order to test the hypothesis that prohy steroids would improve combat survival (didn't, I was told) anyway, nerve gas treatment data is not easily forthcoming, I assume for obvious security reasons... Anyway, thanks for the comment

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