Prioritizing

I had a class in Toxicology today. The treatment for one particular poisoning (a common agent used in chemical warfare) is heroic doses of Atropine. The professor mentioned that if this agent was used in a major city, there would only be enough Atropine to treat about 10 patients.

That got me thinking. If I was ever a physician with 1000 poisoned patients in my care, how could I make the decision on who gets the life-saving treatment and -- more importantly -- who doesn't? Is first-come first-served the most fair method? Do I treat the oldest, the youngest, the most productive to society? What if the president ordered me to give preferential treatment to his son? What if the president was intoxicated, do I give him/her the treatment, no matter what protocol I was working under? Does he deserve it more than the 50 year old providing for 2 kids in college, a wife, and a mortgage?

I honestly don't know what I would do in that situation. Typically, I make fast decisions on my feet, and that's why people usually stick me into leadership roles. I do like to go into situations prepared however, so I believe this is worth thinking about. Any thoughts on the subject?

Jam it back in, in the dark.

Originally Posted by Bolide

If not treated, how long does one have to live before absolutely needing to be treated with Atropine?

The most fatal problem is respiratory with bronchial spasms and hypersecretion... think the worst asthmatic attack ever.

With ventillation, possibly an hour? I'm not sure.

There's nowhere I can't reach.

Originally Posted by Ridan Krad

Was there any reason given for why this is? Is Atropine difficult to produce in large quantities or is it just not often needed and thus not kept in large supply? I would think that the scenario of a chemical weapon attack with this agent would prompt some kind of emergency supply of Atropine or something...

Good point. I said in the original post that "Heroic doses of Atropine" would be required. That's because, say you needed a dose of atropine, you would be given 1-2 miligrams. 10 miligrams would be enough to put you into a coma.

For people with organophosphate poisoning, you might have to use 100-500 GRAMS, thousands of times more than a regular dose.

Hospitals would carry enough Atropine to cover any normal use for a long time, but the doses required to treat the intoxication are SO much larger you exhaust the supply extremely fast. I suppose you could use other anticholinergics that might be on hand.

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