N.J. Admin. Code § 8:41-7.22

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:41-7.22 - Standing orders for nerve agent poisoning (optional, at medical director$DQ$s discretion)

(a) The following standing orders (optional, at medical director's discretion) are authorized in the event that an adult patient presents with nerve agent poisoning:

1. Do not enter or attempt to rescue a person in an area suspected or documented to be contaminated with nerve agent poison;

2. Before making patient contact, ensure that appropriate decontamination has been performed. No decontamination is need for pure vapor exposure;

3. Assess the patient for signs of nerve agent toxicity (SLUDGE) and constricted pupils (miosis);

i. SLUDGE stands for:

(1) Salivation (excessive production of saliva);

(2) Lacrimation (excessive production of tears);

(3) Urination (uncontrolled urine production);

(4) Defecation (uncontrolled bowel movements);

(5) Gastrointestinal distress (cramps, hyperactive bowel sounds); and

(6) Emesis (excessive vomiting);

4. Determine the level of exposure;

i. If the level of exposure is mild (that is, the patient is conscious and breathing):

(1) Assess and secure the airway;

(2) Administer high concentration oxygen;

(3) Observe the patient for respiratory distress; and

(4) Establish IV access;

ii. If the level of exposure is severe (that is, the patient is unconscious or if respirations are severely compromised):

(1) Assess and secure the airway;

(2) Administer high concentration oxygen;

(3) Establish IV access;

(4) Administer Atropine 2 mg/kg IV; and

(5) Administer Pralidoxime Chloride 1 gram IV;

iii. If unable to establish IV access, administer Nerve Agent Antidote Kit (NAAK), consisting of auto injectors of Atropine 2 mg and Pralidoxime Chloride 600 mg intramuscularly; and

5. Contact the medical command physician.

N.J. Admin. Code § 8:41-7.22