Holstege C P, Kirk M, Sidell F R
Indiana Poison Center, Indiana University School of Medicine, Indianapolis, USA.
Crit Care Clin. 1997 Oct;13(4):923-42. doi: 10.1016/s0749-0704(05)70374-2.
The threat of civilian and military casualties from nerve agent exposure has become a greater concern over the past decade. After rapidly assessing that a nerve agent attack has occurred, emphasis must be placed on decontamination and protection of both rescuers and medical personnel from exposure. The medical system can become rapidly overwhelmed and strong emotional reactions can confuse the clinical picture. Initially, care should first be focused on supportive care, with emphasis toward aggressive airway maintenance and decontamination. Atropine should be titrated, with the goal of therapy being drying of secretions and the resolution of bronchoconstriction and bradycardia. Early administration of pralidoxime chloride maximizes antidotal efficacy. Benzodiazepines, in addition to atropine, should be administered if seizures develop. Early, aggressive medical therapy is the key to prevention of the morbidity and mortality associated with nerve agent poisoning.
在过去十年中，神经毒剂暴露导致平民和军事人员伤亡的威胁已成为一个更受关注的问题。在迅速评估发生了神经毒剂袭击后，必须强调对救援人员和医务人员进行去污处理并保护他们免受暴露。医疗系统可能会迅速不堪重负，强烈的情绪反应会使临床情况变得混乱。最初，护理应首先侧重于支持性护理，重点是积极维持气道通畅和进行去污处理。应滴定使用阿托品，治疗目标是减少分泌物以及缓解支气管痉挛和心动过缓。尽早给予氯解磷定可使解毒效果最大化。如果发生惊厥，除阿托品外，还应给予苯二氮䓬类药物。早期积极的药物治疗是预防与神经毒剂中毒相关的发病率和死亡率的关键。
