Magnesium and Thermite Poisoning Medication

  • Author: Jayson Tappan, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 3, 2011
 

Medication Summary

Major drugs of use are fluids for resuscitation, oxygen for respiratory support, tetanus prophylaxis, and analgesia. Follow standard therapeutic protocols for thermal burn injury. Antibiotic therapy, including topical agents (eg, silver sulfadiazine) and intravenous or oral agents, may be needed. Therapy for UV keratitis includes ophthalmological antibiotics and oral or intravenous pain medication.[9]

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Gases

Class Summary

Oxygen is used to support respiration and metabolism.

Oxygen

 

Used to support respiration and metabolism.

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Electrolytes

Class Summary

These agents are used to maintain hydration and salt balance.

Lactated Ringer with normal saline

 

Usually crystalloids such as normal saline or Ringer lactate; little indication for colloid use in acute burn management.

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Topical burn treatment

Class Summary

This agent provides topical burn-healing and antimicrobial properties.

Silver sulfadiazine (Silvadene)

 

Contains both a sulfa antibiotic and a silver ion, which is an antibacterial; speeds burn healing and eases debridement.

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Topical antibiotics

Class Summary

This agent is antibacterial and aids in burn healing.

Bacitracin (AK-Tracin, Baciguent)

 

Mild topical antibiotic, usually in an ointment base, for use on facial burns not deep enough to require grafting.

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Immunizing agents

Class Summary

These agents are used to immunize patients against tetanus.

Tetanus toxoid adsorbed or fluid

 

Used to induce active immunity.

Immunizing agents of choice for most adults and children >7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life.

Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is the mid thigh laterally.

Tetanus immune globulin (TIG)

 

Used for passive immunization of any person with a wound that may be contaminated with tetanus spores.

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Analgesic nonsteroidal anti-inflammatory drug

Class Summary

These agents are used to decrease inflammation and for basic pain control.

Ibuprofen (Advil, Excedrin IB, Ibuprin, Motrin)

 

Usually the DOC for mild to moderate pain, if no contraindications exist; inhibits inflammatory reactions and pain, probably by decreasing cyclooxygenase activity, which results in the inhibition of prostaglandin synthesis.

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

 

Used for relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which results in prostaglandin synthesis.

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Analgesic, narcotic

Class Summary

This agent is used for severe pain from burns or UV keratitis.

Acetaminophen and codeine (Tylenol #2, Tylenol #3, Tylenol #4)

 

Combines analgesic effects of a centrally acting opium-derived alkaloid (codeine) and a peripherally acting nonopioid analgesic (acetaminophen). Indicated for treatment of mild to moderate pain.

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Antibiotic, Ophthalmic

Erythromycin ophthalmic (E-Mycin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

Moxifloxacin ophthalmic (Vigamox)

 

Indicated to treat bacterial conjunctivitis. Elicits antimicrobial effects. Inhibits topoisomerase II (DNA gyrase) and IV enzymes. DNA gyrase is essential in bacterial DNA replication, transcription, and repair. Topoisomerase IV plays a key role in chromosomal DNA portioning during bacterial cell division.

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Contributor Information and Disclosures
Author

Jayson Tappan, MD  Staff Physician, Department of Emergency Medicine, National Naval Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Robin A C Marshall, MD  Core Staff Physician, Assistant Residency Director, Civil Service Advocate, Department of Emergency Medicine, Naval Medical Center Portsmouth; Consulting Staff, Department of Emergency Medicine, Riverside Emergency Physicians, Riverside Regional Medical Center

Robin A C Marshall, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Keim, MD  Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jonathan L Burstein, MD, to the development and writing of this article.

References
  1. Chemical casualties. Smokes, fuels, and incendiary materials. J R Army Med Corps. Dec 2002;148(4):395-7. [Medline].

  2. Stewart CE, Sullivan JB, eds. Military munitions and antipersonnel agents. In: Hazardous Materials Toxicology. 1992:1007-1008.

  3. Mendelson JA. Some principles of protection against burns from flame and incendiary munitions. J Trauma. Apr 1971;11(4):286-94. [Medline].

  4. Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia: Mosby Elsevier; 2006.

  5. Tintinalli, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill; 2004.

  6. Kaye P, Young H, O'Sullivan I. Metal fume fever: a case report and review of the literature. Emerg Med J. May 2002;19(3):268-9. [Medline].

  7. Spector J, Fernandez WG. Chemical, thermal, and biological ocular exposures. Emerg Med Clin North Am. Feb 2008;26(1):125-36, vii. [Medline].

  8. Warden CR. Respiratory agents: irritant gases, riot control agents, incapacitants, and caustics. Crit Care Clin. Oct 2005;21(4):719-37, vi. [Medline].

  9. Curreri PW, Asch MJ, Pruitt BA. The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations. J Trauma. Aug 1970;10(8):634-42. [Medline].

  10. US Department of Transportation. Emergency Response Guidebook. 2004.

  11. Schwartz SI, ed. Principles of Surgery. 8th ed. New York: McGraw Hill; 2004.

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