FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Suspected organophosphate/nerve-agent poisoning under B-035 and the stated ALS direction.
Contraindications & local exclusions
- The DuoDote label lists no absolute contraindications. Its fixed-dose auto-injector is labeled for adults and pediatric patients weighing more than 41 kg; smaller-patient OCEMS instructions must be checked separately.
Precautions
- Watch for atropine-related tachycardia, reduced sweating/heat injury, glaucoma and urinary retention. Decontamination and protective measures remain essential; an auto-injector is not a substitute for exposure control.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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.
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.
UNDERSTAND THE CARE
Why a combination autoinjector needs its own pathway
DuoDote combines atropine and pralidoxime in a fixed device. Its use depends on the exposure and the local age, weight and provider-direction criteria. It should not be substituted for an unrelated atropine indication merely because the name of one ingredient is familiar.
Applying the guidance
Identify the device, review the complete local instructions and account for any prior antidote use. Scene and exposure safety remain part of care. Document the suspected agent, findings supporting treatment, device count, time and response so ALS and the receiving team understand exactly what was delivered.
Diagram text & teaching checkpoints
- Exposure
- Specific organophosphate/nerve-agent concern.
- Eligibility
- Age, weight and required direction.
- Device
- Fixed combination and exact instructions.
- Record
- Device count, time and clinical response.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- B-035 — DuoDote Antidote Autoinjector
- 325.00 — Advanced Life Support (ALS) Provider Unit Minimum Inventory
- SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent
- SO-P-085 — Substance Overdose / Poisoning - Pediatric
- Product label — DUODOTE- atropine and pralidoxime chloride kit
- Name / formulation reference — Medication name and formulation terminology
Reconcile devices across the decontamination handoff
A patient may pass through rescue, decontamination and medical care before reaching the transporting crew. An antidote record should travel with the patient. Ask the transferring clinician which device was used, how many complete devices were given, when and where they were administered, and what changed afterward. If the answer is unknown, communicate that uncertainty instead of recording zero prior treatment.
For example, “two injectors already given” is useful only after identifying that they were DuoDote rather than another autoinjector or a separately drawn medication. Carry that distinction into the treatment decision and receiving-facility report. Do not count a combination device as if it were a generic atropine syringe.
Continue the exposure-control and clinical reassessment process. The B-035 eligibility and severity instructions remain the local reference; the product label has its own weight language. A discrepancy is a reason to use the stated clinical direction and exact local pathway, not to estimate a partial device dose.
Source: DuoDote Antidote Autoinjector.