Biomedical subjects
Publications and source records attributed to Robert G Hendrickson.
Terrorist attack by chemical, biologic, or radiologic agents is a prime concern of emergency planners, and would likely lead to casualties that require critical care. This article reviews the past military and terrorist uses of these agents and reviews the most likely agents to be used by terrorists against civilian populations.
Decontamination is the removal or reduction of chemical, biologic, or radiologic agents from the patient's skin, mucosa, lungs, and gastrointestinal tract. Decontamination is an important step in decreasing the clinical effects of the agent on the patient, as well as protecting coworkers from exposure. For most agents and the vast majority of scenarios, the removal of clothing and a simple 5- to 6-minute shower with soap and water is sufficient to eliminate the risks to the patient and hospital staff. In rare circumstances, additional steps in decontamination including gastric lavage, broncho-alveolar lavage, surgical removal of wound foreign bodies, and administration of activated charcoal, polyethylene glycol electrolyte solution, and radioisotope binding agents, may be necessary.
Ricin is a potent toxin found within the beans of the castor plant. Ricin's widespread availability makes it a viable biological weapon. Ricin intoxication mimics a variety of disease states, thus a low threshold of suspicion must be maintained to recognize a potential epidemic. Treatment is largely supportive.
BACKGROUND: Hydrogen sulfide is a colorless, odorless gas that may cause rapid loss of consciousness and respiratory depression without warning. It has produced toxicity in workers in numerous industries and occupations. METHODS: A review of the United States Bureau of Labor Statistics (USBLS) Census of Fatal Occupational Injuries (CFOI) for occupational deaths related to hydrogen sulfide from 1993 to 1999 was performed. RESULTS: Fifty-two workers died of hydrogen sulfide toxicity in this 7-year period. Deaths were most commonly reported in workers who were white (85%), male (98%), and in their first year of employment with the company (48%). Common industries included waste management, petroleum, and natural gas. In 21% of cases, a co-worker died simultaneously or in the attempt to save the workers. CONCLUSIONS: Hydrogen sulfide toxicity is uncommon, but potentially deadly. Toxicity is predominantly in new workers and co-worker fatalities occur in a significant minority of cases. Proper training and education on the warning signs of hydrogen sulfide toxicity may help reduce worker fatalities.
Pilocarpine has been used as an ophthalmologic agent for decades; however, toxicity rarely has been reported in the medical literature. Oral pilocarpine tablets, as well as another muscarinic agent (cevimeline), have recently been approved for the treatment of dry mouth (xerostomia). We report a case of unintentional overdose of oral pilocarpine tablets that resulted in bradycardia, mild hypotension, and muscarinic symptoms in a patient with Sjogren's syndrome. The patient's symptoms were relieved with 0.5 mg intravenous atropine and she recovered uneventfully. The case is unique in that it is the first reported ingestion of oral pilocarpine tablets and the first dosing error reported for this indication. In addition, this case underscores the importance of communication between physician and patient and the resulting toxicity related to miscommunication.
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Intrathecal baclofen is used as a muscle relaxant and antispasmodic in cases of spasticity resulting from central nervous system trauma. The baclofen withdrawal syndrome may include hyperthermia, tachycardia, hypertension, seizures, altered mental status, and psychomotor agitation. We report a case in which the removal of a baclofen pump lead tothe development of severe withdrawal symptoms despite oral baclofen replacement therapy. In order to avoid the development of withdrawal, adequate doses of GABA agonist agents should be administered immediately prior to, and following, baclofen pump removal.
Quetiapine is an atypical antipsychotic agent with structural similarities to the tricyclic antidepressants (TCA). We report a case of quetiapine overdose that was initially clinically similar to that of a TCA overdose and caused a false-positive TCA immunoassay. We then analyzed three common TCA immunoassays [Microgenics (formerly Diagnostic Reagents, Inc.) Tricyclics Serum Tox EIA Assay, Syva RapidTest d.a.u., and Biosite Triage Panel for Drugs of Abuse] with quetiapine in solution as well as urine from both an overdose patient and a therapeutic patient. There was significant variation of the cutoff of false-positivity in all three immunoassays. Both the Syva and Microgenics immunoassays tested positive in both the overdose and therapeutic samples and were positive at urine levels of 100 microg/mL and 10 microg/mL, respectively. The Triage immunoassay was negative in solutions up to 1000 microg/mL and negative in both the therapeutic and overdose urine samples. Quetiapine may cause false-positive TCA immunoassay with both therapeutic use and in overdose. Significant variation exists between immunoassays to detect quetiapine as a false-positive test.
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This report describes the consensus recommendations of an expert panel convened to develop recommendations for a hospital-based emergency department (ED) to attain a minimal level of preparedness necessary to respond to mass casualty events derived from the use of weapons of mass destruction. The recommendations were created for use by hospital-based EDs of a variety of sizes and locations (urban, suburban, or rural). The disasters that were considered included those that are biological, chemical, or radiological. The panel focused on preparation for a single disaster that could generate 250-500 total patients in 24-48 hours. This number included asymptomatic, exposed, and symptomatic patients. The panel chose not to address circumstances where a small number of patients with an infectious disease are seen in one or a few hospitals. In addition, the panel believed that preparation of a single hospital for an overwhelming mass casualty situation (e.g., 10,000 patients) would not be broadly applicable and would not be required for an individual ED to "minimally prepared." Prior to the convening of this consensus panel, in June 2002, a search of all relevant agencies found no comprehensive, published, validated recommendations for preparedness for individual EDs. Although several agencies had released information on disaster management, clinical diagnosis and treatment tools, and training, no agency had produced a comprehensive list of items and issues that individual EDs must consider when preparing for a terrorist attack. The current report attempts to fill this void in information regarding ED preparedness.
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