Fourth Generation Agents

Exposure Routes

• The most likely route of exposure is skin contact, but FGAs can also be absorbed into the body by inhalation, mucous membrane contact (eyes, nose, mouth), or ingestion. After exposure, symptoms may occur within minutes to hours or up to 3 days. Prompt administration of decontamination procedures and medical evaluation are critical.

Signs/Symptoms

• The presentation and timing of symptom onset depends on the agent, dose, and route of exposure. Regardless of the route of exposure, patients may demonstrate some combination of SLUDGE and DUMBBELS.

  SLUDGE – Salivation, Lacrimation, Urination, Defecation, Gastrointestinal upset, Emesis

  DUMBBELS – Defecation, Urination, Miosis/Muscle weakness, Bronchospasm/Bronchorrhea, Bradycardia, Emesis, Lacrimation, Salivation/Sweating

• Seizures, coma, and death may occur in severe exposures.