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The clinical syndrome of nerve agent toxicity varies widely, ranging from the classic cholinergic syndrome to flaccid paralysis
and status epilepticus.
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All nerve agents are capable of producing marked neuropathology. Seizure control is strongly associated with protection against
acute lethality and brain pathology.
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The mainstays of therapy of nerve agent poisoned patients are atropine, pralidoxime, and benzodiazepines.
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Fosphenytoin provides little therapeutic anticonvulsant effectiveness for nerve agent-induced status epilepticus.
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Tachycardia is not a contraindication to treatment with atropine in nerve agent toxicity.
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Atropine should be administered to alleviate respiratory distress, symptomatic bradycardia, and as an adjunct to benzodiazepines
and pralidoxime to alleviate seizure activity.
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In significant nerve agent toxicity, a continuous pralidoxime infusion may be considered.
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