Think Fast, Sarin Gas

• Clear, colorless liquid that can be absorbed by inhalation, ingestion, skin, or eye contact. A small volume can be lethal within minutes 
• Organophosphorus compound that inhibits acetylcholinesterase resulting in increased acetylcholine at neuromuscular junctions
• Muscarinic effects: SLUDGE (salivation, lacrimation, urination, defecation, GI distress, emesis), miosis
• Nicotinic effects: initial fasciculations, eventual paralysis
• CNS effects: anxiety, cardiopulmonary depression, seizure, coma
• Protect yourself and your staff, ensure decontamination prior to treatment
• Treating the patient:
• Atropine, muscarinic receptor blocker: Reverses SLUDGE
• Pralidoxime (2-PAM), removes cholinesterase inhibitor from cholinesterase: Reverses respiratory muscle paralysis
• Diazepam, for treatment and prevention of seizures
• Early intubation given respiratory failure is the primary cause of death

Reference: 

https://www.atsdr.cdc.gov/csem/cholinesterase/docs/cholinesterase.pdf