# DuoDote (atropine / pralidoxime)

Combination auto-injector for organophosphate/nerve-agent toxicity, with age and weight restrictions.

Population: Adult & pediatric guidance. Scope: BLS / ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked procedure for revision and implementation dates. Source checked September 16, 2026..
Canonical page: https://www.ocmedic.com/guides/duodote/
Official source: [B-035 — DuoDote Antidote Autoinjector](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12434.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- For patients older than 65, B-035 requires weight of at least 80 kg to receive an auto-injector.
- Do not exceed 3 devices unless definitive medical care is available. Ensure scene safety and move to a safe area when possible.

## Source documents

- [B-035 — DuoDote Antidote Autoinjector](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12434.pdf#page=1)
- [325.00 — Advanced Life Support (ALS) Provider Unit Minimum Inventory](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/325.00%20ALS%20Minimum%20Equip%2010-2025.pdf)
- [SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf)
- [SO-P-085 — Substance Overdose / Poisoning - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf)

## Use in OCEMS

- For possible/known organophosphate insecticide or nerve-agent exposure with a compatible cholinergic syndrome.
- B-035 uses salivation, tearing, urination, defecation, GI upset, emesis, and constricted pupils to describe the syndrome.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Respiratory distress with cholinergic findings | 2 auto-injectors under the B-035 table. |
| Severe respiratory distress with agitation and cholinergic findings | 3 auto-injectors under the B-035 table. |
| No signs/symptoms | Monitor for findings every 15 minutes; the table does not instruct prophylactic injection. |

## Pediatric

- For patients younger than 12, B-035 requires a weight of at least 30 kg to receive an IM auto-injector.
- For a smaller child, do not improvise a partial auto-injector dose; use the pediatric poisoning standing order and medical direction.

## Pediatric dose by age / weight

- B-035: weight determines eligibility in children younger than 12; clinical signs determine the number of complete devices. Do not divide an auto-injector.
| Age / weight | Clinical findings | IM auto-injectors |
| --- | --- | --- |
| Younger than 12 and below 30 kg | Any findings | Not eligible under B-035; pediatric poisoning pathway/base direction |
| Younger than 12 and at least 30 kg, or age 12–14 | Respiratory distress with SLUDGEM | 2 devices |
| Younger than 12 and at least 30 kg, or age 12–14 | Severe respiratory distress, agitation, and SLUDGEM | 3 devices |
| Eligible child; no symptoms | No respiratory distress / SLUDGEM | Monitor every 15 minutes; no prophylactic dose |

## Preparation & reassessment

- Use the mid-anterolateral thigh. Remove the safety release, apply the injector at 90°, and hold for at least 10 seconds as specified by B-035.
- Control/dispose of the exposed needle safely. Document product, time, and site; seek medical evaluation after the incident.