Case reports, case series, animal studies, clinical guidelines, and reviews were included. The literature search was limited to articles published in English with a focus on emergency medicine and clinical presentation with no geographical limitations.
Emergency physicians with experience in the critical appraisal of the literature decided which studies to include for the review by consensus. A total of articles were found on the initial search after the removal of duplicate articles. Three full-text articles were not included due to not being in English.
A total of 19 articles were selected for inclusion. Several animal studies provide insight into the pathophysiology behind the adverse side effects of RDX.
Bannon et al. Quinn et al. In another study with Crouse et al. However, the side effects preceding death included tonic-clonic convulsions and weight loss secondary to GI toxicity [ 13 ]. A follow-up neurotoxicogenomic study executed with a cDNA microarray identified that Northern Bobwhites that exhibited RDX-induced seizures had 20 times more RDX in the brain tissue as compared to those of the non-seizing birds with a non-lethal dose.
Burdette et al. The amygdalas of these rats showed accelerated kindling or increased electrical stimulation, suggesting they may participate in RDX-induced seizure susceptibility [ 16 ]. In another study with rats, Williams et al. In essence, the toxic effects seen from RDX exposures may be secondary to various mechanisms, including gene modification and GABA receptor inhibition. The presenting signs and symptoms of C4 toxicity range from headache, fever, nausea, and vomiting to lethargy and generalized seizures [ 8 , 17 - 19 ].
GI symptoms can present several hours after ingestion and usually occur earlier than CNS symptoms [ 8 , 16 ]. In order of presentation, CNS symptoms usually begin with confusion, hyperirritability, myoclonic seizures, and generalized tonic-clonic seizures [ 4 , 7 , 19 ]. Other findings that have been observed include tachycardia, hematuria, proteinuria, and oliguria [ 9 , 17 - 18 ]. RDX ingestion has been associated with several laboratory abnormalities, including leukocytosis, transaminitis, metabolic acidosis, elevated blood urea nitrogen BUN and creatinine, increased creatine kinase CK , and myoglobinuria [ 6 - 7 , 17 - 18 ].
A chest X-ray may reveal signs of pneumonitis secondary to gastric aspiration due to the effects of polyisobutylene, another component of C4 that should be managed appropriately [ 8 , 17 - 19 ]. The initial assessment of all these patients includes a focused history and physical examination. Co-ingestions should be considered, as several reports describe military personnel who have combined C4 with ethanol when presenting with C4 toxicity [ 17 - 18 ].
Hyperreflexia in the setting of acute RDX ingestion has been reported, but overall examination findings are nonspecific [ 4 , 17 - 19 ]. The management of patients who present with C4 ingestion focuses on symptomatic and supportive treatment. It is reasonable to manage them in an algorithmic fashion, beginning with airway maintenance and the prevention of gastric aspiration. The electrocardiogram ECG may show potential arrhythmias from polyisobutylene; however, no arrhythmia specific to RDX toxicity has been identified [ 8 ].
In addition, several studies demonstrate that RDX is non-dialyzable and has a slow absorption rate [ 8 - 9 , 17 - 18 ]. With this consideration, decontamination such as adsorption with activated charcoal is reasonable [ 8 ].
Seizures have been consistently reported with RDX ingestions. Standard doses of lorazepam and diazepam have been effective in terminating initial grand-mal seizures [ 8 , 18 - 19 ]. The efficacy and necessity of continued antiepileptic medication after the initial RDX-induced seizure is uncertain.
If available, a serum RDX level would be helpful to correlate clearance and overall recovery. After the initial management of hemodynamic abnormalities and seizure control, patients require judicious fluid support and the monitoring of urine output given the potential renal complications of hematuria, proteinuria, and oliguria that have been reported after ingestion [ 8 , 17 - 18 ]. Admission to the medical intensive care unit ICU with telemetry and monitoring ECG, noninvasive blood pressure, pulse oximeter has been reported [ 8 , 17 - 19 ].
Reports suggest that patients do not develop subsequent seizures after initial presentation thus EEG monitoring is unlikely to change management [ 7 , 17 - 18 ]. C-4 is a plastic explosive used in military units and in select civilian settings. There are few reports or studies that identify the toxicities of C4. Based on previous reports, the toxic presentation is transient and treatment is supportive.
Critical actions include airway maintenance, seizure control, and fluid resuscitation. Although a rare occurrence, C4 toxicity should be considered in the workup of an undifferentiated seizure in a healthy patient, especially in populations that use or have access to explosives. This manuscript did not utilize any grants or funding, and it has not been presented in abstract form. The chemical TATP belongs to a group of molecules named peroxides, which contain weak and unstable oxygen-oxygen bonds, and that are not found in TNT.
This means that TATP is a lot less stable and more prone to spontaneously exploding. These bonds are extremely unstable, since nitrogen atoms always want to come together to produce nitrogen gas because the triple bond in nitrogen is very strong and stable. And the more nitrogen-nitrogen bonds a molecules has, like RDX, typically the more explosive it is. It is also commonly used in controlled demolition of buildings.
One of the most powerful explosive chemicals known to us is PETN , which contains nitro groups which are similar to that in TNT and the nitroglycerin in dynamite.
But the presence of more of these nitro groups means it explodes with more power. It is now also used in the exploding-bridgewire detonators in nuclear weapons. Among the least stable nitrogen-explosives is aziroazide azide which has 14 nitrogen atoms, with most of them bonded to each other in successive, unstable nitrogen-nitrogen bonds — making them prone to explosion. A former US Marine, Trevor Reed, has gone on hunger strike in hunger to protest against his prison sentence Poland's Prime Minister Mateusz Morawiecki met with soldiers guarding the border with Belarus on Tuesday, as authorities braced for A Marine Corps veteran and business owner who opened his first Connecticut location says his goal is to support It doesn't exist officially.
It uses highly pressured mercury accelerated by nuclear energy to produce a plasma that creates Video Shock and Awe. Related Topics Air Force Topics.
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