management of suspected FGA exposures differs from the approach used for traditional nerve agents All individuals suspected of having been exposed need to be identified, decontaminated, and observed, with serial determinations of RBC cholinesterase or plasma cholinesterase as well as heart rate and temperature monitoring Meanwhile, epidemiologic clues may lead to the identification of additional possibly exposed individuals A-series agents are difficult to treat once victims have gone into cholinergic crisis; aggressive treatment with atropine and an oxime is needed along with scopolamine (initially mg IV in adults; the dose may be scaled down for children) During the latent period, victims need to be decontaminated thoroughly as soon as possible, although decontamination may be effective even an hour or two after exposure Heart rate, core temperature, and cholinesterase levels in the blood or plasma (or both) should be monitored Pyridostigmine bromide (PB) 30 mg orally every hours in adults (lower doses scaled to body weight are appropriate for children) should be considered; this is normally given as a pretreatment for nerve-agent exposure and is not given after the onset of cholinergic crisis PB is a carbamate anticholinesterase used in anesthesia and in the treatment of conditions such as myasthenia gravis At the time of the 1990 Gulf War, the U.S FDA approved it as a pretreatment to be given before exposure in situations in which the risk of exposure to the traditional nerve agent soman (GD) was high (PB is a pretreatment , or pre-exposure antidotal enhancement, not prophylaxis ; it helps antidotes to work better, but the antidotes still have to be given.) Subsequently, the FDA extended that approval for conditions in which exposure to any nerve agent was likely PB pretreatment is not normally a consideration outside military scenarios, but because of the long latent periods with FGAs, administration of PB during the latent period, when the outside of the body has technically been exposed but the target organs (the CNS, skeletal muscles, smooth muscles, and exocrine glands) have not yet been exposed, could theoretically be of use If a provider–patient relationship exists, PB might be considered when given under informed consent PB will predictably depress cholinesterase levels, but the drop is only about 30% from the preadministration values; if cholinesterase levels drop precipitously during the latent period, or if the heart rate or core temperature decreases by more than 25% from baseline, the patient should be treated for full-blown cholinergic crisis