Recognize and Treat Chemical Weapons: Sarin Gas

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    In this video, Roger Seheult, MD of MedCram discusses chemical weapons and their effects on the human body and how to treat them if you are medical personnel in the field. He discusses sarin gas specifically.  This was used in the last 20-30 years in warfare. Sarin gas was used in Tokyo, Japan in 1995 and in Syria in 2013 where it was used to kill between 300-1700 people.


    Nervous system transmission or passage of signals

    Nerves normally interact with each at synapses. Transmission of information occurs in the body in the synaptic cleft (space between the synapse). When an electrical impulse comes down a nerve, it triggers the release of a compound called acetylcholine into the synaptic cleft. On the postsynaptic neuron are receptors that bind the acetylcholine and cause a stimulation allowing for continued transmission of the electric signal. 

    This signal will eventually terminate in either an organ or muscle to cause the desired action. For example, in a muscle, it will cause contraction. In the mouth, saliva may be secreted.  Dr. Seheult shows a table of the different effects of an electrical impulse and how it results in reactions in the parasympathetic and sympathetic systems. 


    Nervous system termination or stopping of signals

    The body also needs to be able to break down the acetylcholine to prevent ongoing stimulation of the end organ target. There is an enzyme called acetylcholinesterase that breaks acetylcholine down. Then the individual molecules are reabsorbed to be reformed into acetylcholine. This allows for the impulses to be turned off or on quickly.


    How sarin gas works

     Sarin gas affects nerve transmission. It prevents acetylcholinesterase from doing its job by blocking its ability to break down acetylcholine. This results in an elevated concentration in the synaptic cleft of acetylcholine. As a result, there is an overstimulation of the nerve. Furthermore, because there is nothing to break down the acetylcholine there is no termination of the signal.  So the end organs get overstimulated.


    Sarin gas toxicity

    Sarin gas is odorless and colorless. Signs of sarin gas toxicity include convulsions, excessive saliva, pinpoint pupils, blurred vision, frothing at the mouth, low heart rates, and respiratory distress. 


    Sarin gas antidotes. 

    There are two ways to treat patients with sarin gas exposure. One is to administer atropine which stops the ability of acetylcholine to attach to the receptor and helps block transmission. 

    Another is to use 2 PAM or pralidoxime. This blocks the ability of sarin gas to bind to the acetylcholinesterase receptor. This only works if the sarin gas comes off the receptor. There is evidence that the sarin gas, if not removed early from the receptor can experience something called aging and become bound irreversibly to the receptor.

    It is important to give both agents as early as possible to get better results and reversal of the sarin gas. Atropine should be administered first. He shows the dosing for both agents. 2PAM must be given as an infusion. These are the CDC recommendations for this. For medical personnel, it is important to know the biochemistry and pharmacology of these drugs especially if you are treating individuals with this.



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    Cholinesterase Inhibitors: Including Pesticides and Chemical Warfare Nerve Agents (ATSDR) |…

    Pralidoxime (ATSDR) |…

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