CBRN receiving-hospital care — decontamination, nerve agent and ARS

(a) Decontamination. Protect staff with PPE and establish hot/warm/cold zones. Remove all clothing first — this clears the majority of external contaminant. Shower with warm water and soap head-to-toe; contain runoff; verify with survey meter for radiation cases. Do not accept contaminated casualties into the clinical area. Life threats are treated concurrently as safe decon proceeds.^[2]

(b) Nerve-agent antidotes. Clinical diagnosis of cholinergic crisis (miosis, secretions, bronchorrhoea, fasciculations, weakness, seizures). Give atropine 2 mg IV and repeat rapidly until secretions dry (large cumulative doses often needed). Give pralidoxime ~30 mg/kg IV early to reactivate acetylcholinesterase before aging (irreversible dealkylation) — soman ages within minutes, so delay forfeits oxime benefit. Support airway, benzodiazepines for seizures. Cyanide differential: hydroxocobalamin 5 g IV if indicated.^[2][3]

(c) ARS biodosimetry. Early prodromal vomiting (especially within the first hour) predicts high whole-body dose. Serial absolute lymphocyte counts over 24–48 hours (Andrews lymphocyte-depletion kinetics) estimate dose and prognosis; rapid fall implies severe marrow injury. Supportive care, reverse isolation considerations, cytokines/haematology support as indicated; externally decontaminated patients are not a major staff irradiation risk — do not delay resuscitation from fear alone.^[1]