每日一题_2022.4.17

A notice from the Department of Public Health and Homeland Security states that someone has claimed to have released a toxin into a nearby subway station. Within the hour, dozens of patients begin to arrive at the hospital for evaluation. Initially, they are asymptomatic. However, while being monitored over the next two hours, they begin to report double vision, slurred speech, and difficulty speaking. Some patients begin to have trouble lifting their arms, and some are noted to be gasping for air using accessory muscles.

Which of the following are the most likely cause of the symptoms and the most appropriate treatment?

A. Botulism, mechanical ventilation

B. Organophosphate poisoning, pralidoxime 

C. Sarin gas poisoning, atropine

D. Cyanide poisoning, hydroxocobalamin

E. Anthrax, ciprofloxacin

答案解析：

肉毒中毒是由于接触肉毒梭菌的毒素引起的；摄入或吸入时可发生，以及伤口感染。肉毒中毒症状为：下行性瘫痪伴颅神经功能障碍，最终进展为通气障碍，无发热及精神改变。肉毒中毒的诊断在很大程度上是临床的，但可以通过生物测定或血液中毒素的检测来证实。初始治疗可能包括机械通气的支持治疗和给予马源性七价(A-G)抗毒素，可从疾病控制和预防中心获得。重症监护医生不仅应该意识到肉毒中毒的影响，还应该意识到当地和区域资源以及在生物恐怖主义攻击的情况下的规划。

有机磷中毒和沙林中毒均表现为经典的SLUDGEM综合征：流涎、流泪、排尿、出汗、胃肠道不适、呕吐、瞳孔缩小。两者均可用阿托品或解磷定治疗。氰化物中毒表现为全身无力，伴有头痛、意识模糊、癫痫发作等神经系统症状，心律失常、低血压等心脏症状。高浓度氰化物可迅速致死。吸入性炭疽的最初体征和症状是咽喉痛、呼吸短促、轻度发热、疲乏和肌肉疼痛。治疗包括环丙沙星。

正确答案：A

补充内容：Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021