Evidence for the 1-hour bundle release by the Surviving Sepsis Campaign is weak. Yet, this is the new standard we are held to, despite ACEP, AAEM, and thousands of physicians, EM and non-EM alike, voicing concern that this is a very bad idea.
Management of nerve agent (NA) poisoning requires recognition of the syndrome and availability of the antidote. It is important to remember that besides the classic “SLUDGE” and “Killer B’s,” there is also the nicotinic syndrome which can cloud the clinical presentation. Add the “weekdays” mnemonic for nicotinic effects to your list of symptoms in NA toxicity.