The treatment of nerve agent poisoning is still a major challenge for medical services. The high toxicity of these agents calls for specific methods for self-protection, e.g. wearing full personal protective gear, for as long as contamination cannot be excluded. Patients are at risk due to the fast onset of life threatening cholinergic crisis. Accordingly, therapy has to start as early as possible. As inhibition of acetylcholinesterase is considered to be the main toxic mechanism of nerve agents, treatment is directed towards antagonizing the effects of cholinergic overstimulation. To this end, atropine has to be applied according to the severity of poisoning. In order to achieve a fast and adequate therapeutic effect, it appears rational to start with a bolus dose of 2 mg that should be doubled every 5–10 minutes for as long as there is no clinical benefit. In severe cases, atropine therapy should be maintained by continuous infusion. For reactivation of inhibited acetylcholinesterase, oximes also have to be administered as soon as possible at adequate doses and for as long as sufficient reactivation may be expected. For therapy of convulsions and reduction of neurotoxic effects, benzodiazepines should be administered. In addition, further supportive measures, e.g. artificial ventilation, should be used to improve the clinical situation of the patient.