Emergency medicine clinics of North America
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Organophosphates (OPs) and carbamates have a wide variety of applications, most commonly as pesticides used to eradicate agricultural pests or control populations of disease-carrying vectors. Some OP and carbamates have therapeutic indications such as physostigmine. Certain organophosphorus compounds, known as nerve agents, have been employed in chemical warfare and terrorism incidents. ⋯ In the setting of toxicity from either agent class, clinical syndromes result from excessive nicotinic and muscarinic neurostimulation. The toxic effects from OPs and carbamates differ with respect to reversibility, subacute, and chronic effects. Decontamination, meticulous supportive care, aggressive antimuscarinic therapy, seizure control, and administration of oximes are cornerstones of management.
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Emerg. Med. Clin. North Am. · Feb 2015
ReviewToxic Industrial Chemicals and Chemical Weapons: Exposure, Identification, and Management by Syndrome.
Toxidromes aid emergency care providers in the context of the patient presenting with suspected poisoning, unexplained altered mental status, unknown hazardous materials or chemical weapons exposure, or the unknown overdose. The ability to capture an adequate chemical exposure history and to recognize toxidromes may reduce dependence on laboratory tests, speed time to delivery of specific antidote therapy, and improve selection of supportive care practices tailored to the etiologic agent. This article highlights elements of the exposure history and presents selected toxidromes that may be caused by toxic industrial chemicals and chemical weapons. Specific antidotes for toxidromes and points regarding their use, and special supportive measures, are presented.
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Emerg. Med. Clin. North Am. · Feb 2015
ReviewChecklists for Hazardous Materials Emergency Preparedness.
Preparation for, and response to, hazardous materials emergencies requires both preplanning and just-in-time information management. The development of an emergency operations plan and a hazardous materials incident response plan involves many steps and implicates numerous resources: institutional, governmental, and private. ⋯ The availability of resources, human and informatics, as well as the means for accessing them, inevitably changes over time. The reader is advised to update all links and telephone numbers on a regularly scheduled basis.