Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T22:45:46.479Z Has data issue: false hasContentIssue false
  • English
  • Français

Single-Breath-Count Test: An Important Adjunct in the Triaging of Patients in a Mass-Casualty Incident Due to Botulism

Published online by Cambridge University Press:  28 June 2012

Paul P. Rega ,
Christopher E. Bork ,
Kelly Burkholder-Allen ,
Michael S. Bisesi  and
Jeffrey P. Gold
Paul P. Rega*
Affiliation:
College of Medicine, Department of Public Health, University of Toledo, Toledo, Ohio
Christopher E. Bork
Affiliation:
College of Medicine, Department of Public Health, University of Toledo, Toledo, Ohio
Kelly Burkholder-Allen
Affiliation:
College of Medicine, Department of Public Health, University of Toledo, Toledo, Ohio
Michael S. Bisesi
Affiliation:
College of Medicine, Department of Public Health, University of Toledo, Toledo, Ohio
Jeffrey P. Gold
Affiliation:
College of Medicine, Department of Public Health, University of Toledo, Toledo, Ohio
*
5658 Bernath Court, Toledo, Ohio 43615, USA E-mail: Paul.Rega@utoledo.edu OR NDMSMD@aol.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Clostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative. The purpose of this article is to propose the adoption of the Single-Breath-Count Test (SBCT). The ease and validity of the use of the SBCT in evaluating complications associated with various neuromuscular disorders make it an attractive adjunct for triage during a mass-casualty incident due to botulism. While education, immune globulin, antitoxin, and invasive airway techniques are well-recognized steps in treating botulism, incorporating a time-honored technique such as the SBCT, will be an important addition to the triage process.

Keywords

botulismmass-casualty incidentsingle-breath-count testtoxintriageventilatory failure
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 3 , June 2010 , pp. 219 - 222
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Timmon, RA, Carbone, AJ: Botulism: The Most Toxic Substance Known. In: Keyes, DC, (ed), A Medical Response to Terrorism, Preparedness and Clinical Practice. Philadelphia: Lippincott, Williams, and Wilkins, 2005, pp 117–126.Google Scholar
2.Arnon, SS, Schechter, R, Inglesby, D, et al: Botulinum toxin as a biological weapon. JAMA 2001;285:1059–1070.CrossRefGoogle ScholarPubMed
3.Koirala, J, Basner, S: Botulism, botulinum toxin, and bioterrorism: Review and update. Infect Med 2004;21:284–290.Google Scholar
4.Wein, LM, Liu, Y: Analyzing a bioterror attack on the food supply: The case of botulinum toxin in milk. Proc Natl Acad Sci USA 2005;102:9984–9989.Google Scholar
5.Christian, MD, Devereaux, AV, Dichter, JR, et al: Definitive care for the critically ill during a disaster: Current capabilities and limitations. Chest 2008;133:8S-17S.CrossRefGoogle ScholarPubMed
6.Lerner, EB, Schwartz, RB, Coule, PL, et al: Mass casualty triage: An evaluation of the data and development of a proposed guideline. Disast Med Pub Health Prep 2008;2(Suppl 1):S25–S34.CrossRefGoogle Scholar
7.Mitchell, GW: A brief history of triage. Disast Med Pub Health Prep 2008;2(Suppl 1): S4–S7.Google Scholar
8.Bendett, JO: The neuromuscular respiratory system: Physiology, pathophysiology, and a respiratory approach to patients. Respir Care 2006;51:829–837.Google Scholar
9.Botulism: Current, comprehensive information on pathogenesis, microbiology, epidemiology, diagnosis, and treatment. Available at http://www.cidrap.umn.edu/ cidrap/content/bt/botulism/biofacts/botulismfactsheet.html. Accessed 17 January 2009.Google Scholar
10.Taillac, PP, Kim, J: CBRNE-Botulism. Available at http://emedicine.medscape.com/article/829125-overview. Accessed 17 January 2009.Google Scholar
11.Chan-Tack, K, Bartlett, J: Botulism. Available at http://emedicine.medscape.com/article/213311-overview. Accessed 17 January 2009.Google Scholar
12.Van Rynen, JL, Rega, PP, Budd, C, Burkholder-Allen, K: The use of negative inspiratory force by ED personnel to monitor respiratory deterioration in the event of a botulism-induced MCI. J Emerg Nurs 2009;35(2):114–117.CrossRefGoogle ScholarPubMed
13.Mehta, S: Neuromuscular disease causing acute respiratory failure. Resp Care 2006; 51:1016–1021.Google ScholarPubMed
14.Fulgham, JR, Wijdicks, EFM: Guillain-Barre syndrome. Crit Care Clin 1997;13(1):1–15.Google Scholar
15.Orenstein, DM, Holt, LS, Rebovich, P, et al: Measuring ease of breathing in young patients with cystic fibrosis. Ped Pulmon 2002;34(6):473–477.Google Scholar
16.Jain, VK, Behari, S: Management of atlanto-axial dislocation: Some lessons learned. Neurol India 2002;50(4):386–397.Google Scholar
17.Yavagal, DR, Mayer, SA: Respiratory complications of rapidly progressive neuromuscular syndromes: Guillain-Barre syndrome and myasthenia gravis. Semin Respir Crit Care Med 2002;23(2):221–229.CrossRefGoogle ScholarPubMed
18.Graham, B, Talent, J, Allison, G, et al: World at Risk: The Report of the Commission on the Prevention of WMD Proliferation and Terrorism. New York: Vintage Books, 2008.Google Scholar