مسمومیت با عوامل شیمیایی جنگی اعصاب

Introduction: Organophosphorous (OP) chemical warfare nerve agents are similar to OP pesticides in their structure and toxic mechanisms.. These agents mainly sarin and tabun were used during Iran-Iraq war with high mortalities. Sarin was also used as chemical terrorism in Matsomoto and Tokyo metro in 1994 and 1995, respectively with high morbidity and mortality. Since these lethal agents are still a big threat, medical and even paramedical and nursing staff should obtain enough knowledge about chemical toxicity and be prepared to manage in any chemical events of nerve agents exposure. Toxicity: OP nerve agents are cholinesterase inhibitors, leading to acetylcholine accumulation at nerve endings, stimulating muscarinic and nicotinic receptors. These agents have also direct effects on CNS and to a lesser degree on cardiovascular system. The toxic effects induce manifestations on different systems including nervous, cardiovascular, and gastrointestinal system and organs such as skin, eyes and skeletal muscles leading to death in severely intoxicated patients. Management: In addition to atropine and oximes as known antidotes, based on research in Mashhad poisons centre, cheap available pharmaceuticals including sodium bicarbonate, magnesium sulfate, and antioxidants (vitamins C and E) have recently been used successfully for the treatment of OP poisoning. Conclusion: Chemical warfare nerve agents are highly toxic, and induce high morbidity and mortality in chemical wars and terrorism. Thus, prompt emergency and proper management are required. Medical, paramedical and nursing staff must be aware of and be prepared for any possible chemical nerve agents accidents. Sodium bicarbonate, Magnesium sulfate and the antioxidants should be added to the standard treatment of OP poisonings.