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Kurtzhals P, Havelund S, Jonassen I, et al

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Should only be used when directed by public health officials.8 and 24 hours: 130 mgWithin 1 hourPralidoxime(2- PAM)/ ProtopamCholinesterase Inhibitor poisoning (organophosphate or nerve gas)Also stocked in the Strategic National Stockpile: for mass casualties, local cache may provide supplies for first 48 hours coordinated by state department of health and emergency response system.8 hours: 7 g or 7 x 1 gm (20 mL) vials24 hours: 18 g or 18 x 1 gm (20 mL) vialsWithin 1 hourProtamineHeparin reversalMay also partially neutralize low-molecular weight heparins8 hours: 500 mg or 2 vials (10 mg/mL, 25 mL each)24 hours: 1250 mg or 5 vials (10 mg/mL, 25 mL each)Immediate emergency departmentProthrombin Complex Concentrate (PCC): 3 factor and 4 factorReversal of bleeding from anticoagulants (vitamin K antagonists, direct thrombin inhibitors, factor Xa inhibitors)Specific reversal agents may be available (idarucizumab, andexanet alpha) and Vitamin K