Table 3. Specific Antidotal Treatment for Nerve Agent Intoxication as Recommended by the Israeli Defense Force Medical Corps  6,25 

* Patient walks but suffers from miosis, blurred vision, lacrimation, salivation, chest discomfort, nausea, and vomiting and abdominal pain.

† Patient is lying down, breathing is laborious with marked wheezing and bronchospasm, muscle fasciculation, and urinary and fecal incontinence.

‡ In addition to all of the manifestations mentioned for mild and moderate, patient is apneic. 25 

§ Characterized by the appearance of flushed and dry skin, increased heart rate, and reduced bronchoconstriction and bronchorrhea. Mild and moderately intoxicated patients must be atropinized for at least 24 h. Severely intoxicated patients should be kept fully atropinized for at least 48 h. Adults older than 60 yr should be given additional doses of atropine of only 1 mg each after the initial 2-mg dose. Mildly intoxicated children younger than 2 yr should be given atropine only after careful clinical evaluation and verification of the necessity for additional atropine, since they are more susceptible to atropine intoxication.

# Not recommended for children.

** Repeated doses of pralidoxime at hourly intervals should be given in case of progressive worsening or persistent signs of toxicity. All drugs must be readministered as deemed clinically necessary. An integral part of the antidotal protocol consists of the administration of a benzodiazepine to reduce anxiety and resistance to mechanical ventilation or to control seizures (intravenously or intramuscularly, preferably 0.05–0.1 mg/kg midazolam or 0.2 mg/kg diazepam) in fractionated doses or until the desired effect is achieved.