A stringy-haired pimply teenager in a long trench-coat was found in his room listening to death metal, in a puddle of vomit, having had urinary and fecal incontinence. En route to your hospital he begins to seize. The paramedics who bring him begin to have teary-eyes, vomiting and diarrhea. The police following behind the ambulance, immediately prior to vomiting, say that the kid had plans in his room for an attack at a nearby mall. What is the contaminant? How do you treat this toxidrome?Answer
Nerve gas! Nerve agents like sarin, soman, VX inhibit acetylcholinesterase, thus producing a cholinergic toxidrome. Think juices coming from every orifice, or SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, GI distress, Emesis. Eww. First off, protect yourself with a gown, gloves, and mask. Treatment is decontamination. Remove all clothing and hose the person off. Then treat with atropine and pralidoxime (2PAM) to dry the patient up and reverse paralysis respectively. Insert nerdy pathyphysiology about the muscarinic and nicotinic receptors here. This is a bread and butter board exam question: easy as pie, and unmissable.
Love,
Andy G. and Sally B.
sbogoch
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