Treating Chemical and Biological Agent Casualties

Lesson 2: Treating Nerve Agent Poisoning
Section II: Treat Casualty

2-9. CHECK FOR ATROPINIZATION

Observe the casualty for signs and symptoms of atropinization. Mild atropinization indicates that the casualty has received sufficient atropine.

a. Signs and Symptoms of Mild Atropinization. Chemical operations have shown that if troops become alarmed, some of them may believe that they have been exposed to chemical agents when they actually have not been. That is why it is important that service members not give themselves more than one atropine injection (2 mg) if they do not have progressive signs of nerve agent poisoning and consequent incapacitation. Repeated atropine injections without nerve agent exposure produces progressive signs and symptoms of atropinization characterized as mild, moderate, and severe. If a soldier has absorbed little or no nerve agent, a single injection (2 mg) of atropine will produce mild atropinization symptoms. Mild signs and symptoms of atropinization include:

(1) Dryness of the skin, mouth, and throat with slight difficulty in swallowing.

 

(2) Feeling of warmth and slight flushing.

 

(3) Tachycardia (rapid pulse).

 

(4) Hesitancy of urination.

 

(5) Occasional desire to belch.

 

(6) Feeling of slowed body movements and mildly relaxed.

 

(7) Blurred near vision.

 

NOTE: Symptoms may vary with individual casualties. Since mental reactions may

be slightly slowed, aviators must not fly after taking atropine until they have

been cleared by a flight surgeon.

b. Signs and Symptoms of Moderate Atropinization. If the atropine injection of 2 mg is repeated within one hour, and the casualty has not been exposed to a nerve agent, the following moderate central nervous system symptoms develop in most individuals. They may include:

(1) Drowsiness and fatigue.

 

(2) Slowed memory and ability to recall.

 

(3) A feeling of slowed body movements.

 

(4) Blurring of near vision (near vision may be impaired for more than 24 hours). Soldiers with moderate symptoms can continue some ordinary activity with some loss of efficiency. The effects of the moderate symptoms may last three to five hours.

 

CAUTION: While an unchallenged dose of atropine may allow individuals to

continue normal duties, they may be closely monitored for possible heat

injury. This is particularly important when operation in MOPP4, as the

individual's ability to perspire is reduced due to atropine.

c. Signs and Symptoms of Severe Atropinization. If a third atropine injection of 2 mg is repeated within an hour after the second nerve agent exposure and the casualty has not been exposed to a nerve agent, symptoms will be severe enough to interfere with activities. Additional administration of atropine at frequent intervals will result in severe incapacitating symptoms of overatropinization (nerve agent antidote poisoning). These severe symptoms are:

(1) A very dry mouth, swelling of the tongue and oral mucus membranes.

 

(2) Difficulty in swallowing, thirst, and hoarseness.

 

(3) Dry and flushed skin.

 

(4) Dilated pupils.

 

(5) Tachycardia (rapid pulse).

 

(6) Urinary retention (in older individuals).

 

(7) Constipation.

 

(8) Slowing of mental and physical activity.

 

(9) Restlessness.

 

(10) Headache.

 

(11) Disorientation.

 

(12) Hallucination.

 

(13) Depression.

 

(14) Increased drowsiness.

 

(15) Increased fatigue.

 

(16) Rapid panting respiration.

 

(17) Respiratory distress.