12-1- 4

Question 1

Cholinergics

Answer 1

aka Organophosphates

Classic presentations
-Exposure to nerve agent
-Farmer who ingested an insecticide

Organophosphates can bind permanently to acetylcholinesterase –>
Nicotinic receptor blockage (paralysis and seizures)

Question 2

Cholinergic crisis sx

Answer 2

-Copious secretions
-SLUDGE (salivation, lacrimation, urination, defection, gastrointestinal secretions, emesis)
-Bradycardia
-Miosis
-Bronchorrhea

Question 3

Management of Cholinergic crisis

Answer 3

-High-dose atropine (20-30 mg)*
- *Titrate treatment to drying of secretions
-Benzodiazepines
-Pralidoxime (2-PAM)

Question 4

Atropine for Cholinergic crisis

Answer 4

Atropine 2 mg IV

Double dose q5min until respiratory secretions have cleared

If 25 mg of atropine is needed to control secretions, administer continuous infusion of 2.5-5 mg/h.

may require >100 mg to achieve desired effect.

If intubation is necessary, avoid succinylcholine

Question 5

Traditional teaching divided the neck into 3 anatomic zones and based management on the zone of injury, with mandatory surgical exploration for wounds in ___________–

Answer 5

zone 2 (the mid neck)

*This is now becoming an out of date practice but there you have it

Question 6

Hard Signs of Vascular Injury- neck trauma

Answer 6

Shock
Pulsatile bleeding
Expanding hematoma
Audible bruits
Palpable thrill
Nonpalpable pulse
Signs of cerebral ischemia/stroke

Question 7

Hard Signs of Aerodigestive Injury

Answer 7

Airway compromise
Bubbling wound
Extensive subcutaneous emphysema
Stridor
Significant hemoptysis or hematemesis

Question 8

Soft Signs of Vascular or Aerodigestive Injury- neck

Answer 8

Hypotension with no other etiology
Nonexpanding hematoma
Hoarseness
Dysphonia
Lateralizing neurologic deficit
Unexplained anemia