What is an example of a sign/symptom of exposure to a nerve agent at a hazmat or suspected terrorism incident?

• A. Fever and chills
• B. Cough and runny nose
• C. Rash and itching
• D. Loss of bladder control and vomiting

Answer: (D)

Exposure to a nerve agent causes a surge of acetylcholine at muscarinic receptors, producing a cluster of signs often summarized as SLUDGE: Salivation, Lacrimation, Urination, Defecation, and GI upset (including vomiting). The symptom pair of vomiting and loss of bladder control directly reflects these muscarinic effects on the GI tract and bladder. They are classic, rapid-onset indicators of this kind of exposure at a hazmat or terrorism incident. Fever and chills are not typical of nerve agents, and cough/runny nose or rash/itching fit other conditions or irritants rather than a cholinergic crisis.