Emergency Medicine Book

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Incapacitating Agent

Aka: Incapacitating Agent
  1. See Also
    1. Anticholinergic
    2. Chemical Weapon
  2. Preparations
    1. BZ (Agent 15)
  3. Labs: Detection
    1. No field detector is available
  4. Symptoms and Signs
    1. SEE Anticholinergic Effects
    2. Slurred Speech
    3. Automatic behavior
      1. Perseveration
      2. Disrobing
      3. Phantom behavior (e.g. Wool gathering)
    4. Vivid Hallucinations
  5. Course
    1. Latent Period:
      1. 30 minutes to 4 hours (Up to 36 hours)
    2. Effective Period for 72-96 hours related to dose
      1. Onset Stage: 0-4 hours after exposure
        1. Parasympathetic blockade
        2. Mild CNS effects
      2. Second Stage: 4-20 hours after exposure
        1. Stupor
        2. Ataxia
        3. Hyperthermia
      3. Third Stage: 20-96 hours after exposure
        1. Fluctuating Delirium
      4. Resolution Stage
        1. Paranoia
        2. Deep sleep with eventual reawakening
        3. Crawling or climbing automatisms
        4. Ultimately reoriented
  6. Differential Diagnosis
    1. Delirium
    2. Intoxication
      1. Hallucinogens (e.g. LSD)
      2. Cannabinoids (Marijuana)
      3. Lead
      4. Barbiturates
      5. Bromides
    3. Heat Stroke
    4. Anxiety
  7. Management
    1. Decontamination
      1. Remove contaminated clothing
      2. M291 skin Decontamination kit
      3. Thorough Flushing with soap and water
    2. Antidote
      1. Physostigmine
    3. Supportive care
      1. Monitor core Temperature and vitals
      2. Adequate hydration
      3. Confiscate weapons and potentially harmful items
      4. Restraint as indicated (up to 80% of cases)
    4. Disposition
      1. Early evacuation
      2. Observe for up to 96 hours
  8. References
    1. Medical Response to Chemical Warfare and Terrorism
      1. US Army Medical Research Institute Chemical Defense
      2. Video-Teleconference: 4/20/00 to 4/22/99
      3. Video-Teleconference: 12/5/00 to 12/7/00
      4. Text: 3rd Edition, December 1998

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