2-pam

[Fogy]

We are looking at adding 2-PAM to our drug inventory for the treatment of Organophosphate poisoning as well as the possibility of nerve agents. Does any one currently have this in their drug box and have you gotten a chance to use it yet??

[Trauma_Dog]

The city of Houston's Hazmat unit keeps it in stock, It is used to combat chemical warfare agents. I am told that it could be leathal if given in the wrong setting. You may want to contact the military, they have a web site with some into on it.

------------------
Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX


[This message has been edited by Trauma_Dog (edited April 26, 2000).]

[BURNSEMS]

Please check with Ft Sam Houston Health Science Center in San Antonio before you give out 2pam Chloride for any Reason... 2 Pam Cloride is given in ACUTE cases of Nerve Agent Poisoning,, and must be given after Atropine Injection,, 2 Pam Chloride if my memory serves me Right is a antidoe for Atropine Overdose,,as well as a Nerve Agent Blocker,, Nerve Agents vary greatly from common poisioning you see now days at the Home,,, and It may not work for Organo Phosphates or certain chemical Family Types, now the military gives a Cana Injection after the 2 Pam and Atropine,,, it is a Valium Injection to stop Siezures related to Nerve Agents and 2 Pam Chloride,,, I am sure your Medical Director has Looked into This However great problems have been seen in The Military with its use,,,,

[HossMedic]

Lets go back to basics. Remember back in medic school when they covered the nervous system. Remember that the parasympathetic nervous system breaks down into Muscarinic and Nicotinic receptor sites. Atropine works on the muscarinic sites while 2-pam works on the nicotinic receptor sites. In NYC-EMS each burough has 1 ALS and 1 BLS HAZ-MAT response bus and only the HAZ-MAT ALS units carry 2-pam. This is a stonge medication that should only be used in severe organophosphate poisonings such as those encoutered with chemical warfare. and if by some strange chance you encouter a chemical warfare situation, I strongly suggest you put enough aside for you and your partner before using any on the patients.

stay safe

[dousaems]

Interesting that some of you are carrying it and other that want to. I knew NYC was carrying, but thats due to the WMD thing. As for the use, 2-PAMCl (Pralidoxime Chloride) is utilized in conjunction with Atropine for organophosphate poisonings (which nerve agents are). It has been used safely in lots of cases, and is used on a regular basis in veterinary medicine. In fact, there are autoinjectors of 2-PAMCl on the commercial market.
As for dosing, here's the standards:
Mild exposure (minor SLUDGE) - 2 mg Atropine IM, 600 mg 2-PAMCl IM.
Moderate exposure (SLUDGE with some twitching) - 4 mg atropine IM, 1 g 2 PAMCl IV over 30 min.
Severe - (SLUDGE with seizures) - 6 mg Atropine IM, 1800 mg 2PAMCl IM or 1g IV, 5 - 10 mg Diazepam.
Only major side effects - overdose of 2 PAMCl may cause hypertension that can be reversed with Phentolamine.
This info comes from medical experts in chemical weapons and occupational health issues. Any questions, please contact me.



------------------
Todd Dousa
NREMT-P, CCEMT-P