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Podcast 534: Nerve Agents

Emergency Medical Minute

Release Date: 01/21/2020

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Emergency Medical Minute

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Emergency Medical Minute

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Emergency Medical Minute

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Emergency Medical Minute

Host: Elizabeth Esty, MD Research By: Elizabeth Esty and Nathan Novotny References: Osumi M. Questions raised over COVID-19 reinfection after Japanese woman develops illness again. The Japan Times. https://www.japantimes.co.jp/news/2020/02/28/national/coronavirus-reinfection/#.Xn4coZNKhQI. Published February 28, 2020. Bao L, Deng W, Gao H, et al. Reinfection could not occur in SARS-CoV-2 infected rhesus macaques. bioRxiv. March 2020:2020.03.13.990226. doi:10.1101/2020.03.13.990226 Steinbuch Y. Doctor asks recovered coronavirus patients to be tested for antibodies. New York Post....

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Recorded 3/26/20

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The circumstances surrounding the COVID-19 virus are quickly evolving and that means that EMM will have to as well. For the foreseeable future, EMM will be releasing COVID-19 updates. In this series, we will report the most recent statistics, summarize the newest literature and answer YOUR burning questions. Submit your questions through comments on this post or through private messages on any of our social media platforms. Host: Elizabeth Esty, MD Research By: Elizabeth Esty, Jackson Roos, Nathan Novotny & Mason Tuttle Time Stamps: 0:00 - COVID-19 by the numbers 2:50 - Hydroxychloroquine...

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  Contributor: Don Stader, MD Educational Pearls: PPIs (Proton pump inhibitors) reduce stomach acid levels and are commonly prescribed in patients with GERD or peptic ulcer disease Stopping a PPI after sustained use for a month or longer can lead to withdrawal - causing a rebound indigestion or reflux due to a surge in acid production Long term PPI use has noteworthy side effects including increased incidence of bacterial GI infections and pneumonia Be cautious in prescribing a PPI for over 2 weeks. If continued indigestion control is needed, transition to a H2 blocker or OTC antacids if...

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Emergency Medical Minute

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Author: Michael Hunt, MD

Educational Pearls:

  • Organophosphate “nerve agents” were developed in the 1930’s
  • These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE”
    • Salivation
    • Lacrimation
    • Urination
    • Defecation 
    • GI cramping
    • Emesis 
  • The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis 
  • Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis 
  • Treatment includes atropine to reduce secretions (often in incredibly high doses) and pralidoxime (2-PAM) to treat muscle paralysis 
  • Benzodiazepines may be necessary for seizures

References

https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html

Michael Eddleston Novel Clinical Toxicology and Pharmacology of Organophosphorus Insecticide Self-Poisoning. Annual Review of Pharmacology and Toxicology 2019 59:1, 341-360

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD