Tasty Morsels of EM 087 – #FRCEM Potential Terrorism Agents

27 Jul

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

What is anthrax and how do you manage it?

(From OHEM and Green book)

  • bacillus anthracis
  • usually found in grass eating animals (hence the leather industry exposure) but also big in IDU population in recent years. Also famously posted all around the US
  • causes mainly skin disease in humans but also GI and respiratory
  • usually <48 hrs incubation
  • Cutaneous anthrax
    • usually painless
    • red papule developing into an ulcer
    • septicaemia in 20%

CDC – Public Domain

  • Inhalational anthrax
    • flu like illness
    • cyanosis
    • sub cutaneous oedema
    • mediastinal widening from lymph nodes
    • of note person to person airborne transmission does not occur
  • Management
    • cipro, penicillin, clindamycin (in combination)
    • green book recommends giving the vaccine in addition to treatment

Describe some potential bioterrorChemical agents

  • Organophosphates
  • Chlorine
    • lacrimation, conjunctivitis, coughing and wheezing
    • if severe laryngeal and pulm oedema
    • if severe can give steroids
  • Cyanide
  • CS Gas
    • blepharospasm, lacrimation, coughing
    • resolves in 10 mins of fresh air (with the conjunctivitis a little longer)
    • keep them in a well ventilated space
    • blowing air on the eyes can help vaporise remaining CS

How would you decontaminate a patient

(From OHEM and Rich Carden’s excellent piece on St Emlyns)

  • should be decontaminated at scene
  • protect yourself
  • may have to give antidote while doing decontamination (eg atropine in organophosphate)
  • removing clothing removes most of the contamination. And cut it rather than pull it over the head
  • clean with warm/tepid water



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