Acetylcholinesterase inhibitors
Includes household and commercial pesticides (diazinon and parathion)
G-series (sarin, tabun, soman) and V-series (VX)
G-series are volatile non-persistent agents that evaporate quickly
V-series high viscosity with oily consistency
Rapidly absorbed through skin, symptoms generally develop within 1 hour
Vapors are heavier than air and tend to sink into low places
Sarin used in Tokyo subway attack in 1995; 5,000 sought medical attention with 12 deaths.
G-series are volatile non-persistent agents that evaporate quickly
V-series high viscosity with oily consistency
Inhibits acetylcholinesterase → excess acetylcholine at both nicotinic and muscarinic receptors
DUMBELLS
D-Diarrhea, U-Urination, M-Miosis, B-Bronchorrhea/Bradycardia, E-Emesis, L-Lacrimation, S-Salivation/Seizures
Cholinergic toxidrome Toxidromes
D-Diarrhea, U-Urination, M-Miosis, B-Bronchorrhea/Bradycardia, E-Emesis, L-Lacrimation, S-Salivation/Seizures
Nerve agents prolong succinylcholine's paralytic effect
Atropine for bronchorrhea and bronchoconstriction
Start at 2-6mg, double the dose q5-30min until control of secretions (no max dose)
Pralidoxime to restore function of acetylcholinesterase (given over approximately 30 minutes; rapid infusion can cause hypertension)
Give as soon as possible - must be given before "aging" occurs to be effective
Benzodiazepines for seizures (standard AEDs may be ineffective)
Mark 1 Nerve Agent antidote Kit (NAAK): 2 autoinjectors:
2mg atropine
600mg pralidoxime
DuoDote Autoinjector: 2.1mg atropine, 600mg pralidoxime in one autoinjector
Prophylaxis in the military, high risk setting with pyridostigmine
Reversibly bind acetylcholinesterase before exposure to nerve agents
Pyridostigmine 30 mg PO q8
Start at 2-6mg, double the dose q5-30min until control of secretions (no max dose)
Give as soon as possible - must be given before "aging" occurs to be effective
2mg atropine
600mg pralidoxime
Reversibly bind acetylcholinesterase before exposure to nerve agents
Pyridostigmine 30 mg PO q8
Chemical weapons
Radiation exposure 
Caustic cocktail
Dirty bomb
Bioterrorism
Care under fire
Mass shooting
Hazmat exposure