Nerve Agent Exposure: Recognizing Critical Symptoms and Signs

Severe Signs of Nerve Agent Poisoning (SLUDGE + Killer B’s)

• Salivation (excessive)
• Lacrimation (tearing)
• Urination (involuntary)
• Defecation / Diarrhea
• Gastrointestinal distress (nausea, vomiting, cramps)
• Emesis (vomiting)
• Miosis (pinpoint pupils) – hallmark sign
• Muscle fasciculations, weakness, paralysis
• Bronchoconstriction → dyspnea, wheezing, cough
• Bradycardia then tachycardia; hypertension then hypotension
• Seizures, convulsions
• Loss of consciousness, confusion
• Respiratory failure (primary cause of death)

Immediate Actions

1. Call emergency services (911 in US).
2. Remove from exposure source; decontaminate (remove clothing, flush skin/eyes with water).
3. Administer antidotes if available: atropine (anticholinergic) + pralidoxime (2-PAM) (oxime) + benzodiazepine for seizures.
4. Support airway, breathing, circulation.

This is a medical emergency. Rapid recognition and treatment are lifesaving.