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SBCMS PRIMER ON BIOTERRORISM San Bernardino County Medical Society Chemical Agents Reference Chart
Atropine – initial dose 2 mg. Additional doses until symptoms resolved (will not reverse miosis). Lacrimation.
Pralidoxime Chloride – 1 gram IV over 20–30 minutes. Urination.
Benzodiazepines – for seizure control or to prevent seizures in severely intoxicated patients. Defecation.
Gastric -
Pinpoint pupils
(everything looks
Cyanide Antidote Kit
Amyl nitrite ampule – first aid until IV established. Crush and place inside mask of BVM; 15 seconds of inhalation, then 15 second break; repeat until IV established. Sodium nitrite – 300 mg over 2–4 minutes. Sodium thiosulfate – 12.5 g over 5 minutes. seldom seen. Lactic acidosis and increased concentration of venous oxygen. Fluid balance (do not overhydrate; not a thermal burn). Bronchodilators and steroids for pulmonary symptoms, only if Lewisite is the poison, then BAL is
Treat hypotension with fluid; no diuretics. cardiogenic pulmonary Ventilate with PEEP. Treat bronchospasm with bronchodilators and steroids, as needed. SBCMS PRIMER ON BIOTERRORISM San Bernardino County Medical Society Biological Agents Reference Chart
TBI: treatment may be delayed 24 h. until cultures from incident site available. PEP (only if instructed by govt. officials): ciprofloxacin or doxycycline po x 8 wks. Severe cases: ciprofloxacin, doxycycline, or penicillin IV. stain (gram-positive rod) of blood and blood culture (late). Oral rehydration with WHO solution or IV hydration. Tetracycline, doxycycline (dosage as below or 300 mg one time) po for 3 d. Ciprofloxacin or norfloxacin po for 3 d. if resistant strains. Isolation.
PEP: doxycycline or ciprofloxacin for 7 days Symptomatic: gentamicin or doxycycline IV for 10–14 days. node aspirate, sputum, or CSF (gram negative, non-spore forming rods). Tularemia
Most cases self-limited. Tetracycline or doxycycline po for 5–7 d. Smallpox
PEP: vaccinia vaccine scarification and vaccinia immune globulin IM. erythematous rash that progresses to pustular vesicles. Electron or light microscopy of pustular scrapings. PCR. Encephalitides
Viral Hemorrhagic
Isolation. Supportive care.
San Bernardino County Medical Society


Enterotoxin B
pulmonary edema, and severe respiratory distress. T-2 Mycotoxins
Abbreviations: CSF: cerebro-spinal fluid. CXR: chest x-ray. d: days. h: hours. FLS: flu-like symptoms. GI: gastro-intestinal. I: incubation
PCR: polymerase chain reaction. PEP: post-exposure prophylaxis. TBI: threatened biologic incident. WHO: World Health Organization.
Dosages: Chloramphenicol: 50-75 mg/kg/d, divided q 6 hrs. Ciprofloxacin: po: 500 mg q 12 h.; IV: 400 mg q 8-12 h. Doxycycline: po: 100 mg
q 12 hrs; IV: 200 mg initially then 100 mg q 12 h. Erythromycin: po: 500 mg q 6 h. Gentamicin: 3-5 mg/kg/d. Norfloxacin: po: 400 mg.
Penicillin: IV: 2 million units q 2 h. Tetracycline: po: 500 mg q 6 h. Streptomycin: IM: 15 mg/kg, BID. Vaccinia immune globulin: IM: 0.6
WHO solution: 3.5 g NaCl, 2.5 g NaHCO3, 1.5 g KCl and 20 g of glucose per liter of water.
Compiled by Richard N. Bradley, MD, Asst. Med. Dir., Houston Fire Dept. EMS Division.


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