Neuroterrorism and drug overdose

Knowledge of proper clinical management of drug overdose and chemical and biological toxin exposure is important for the neurocritical care specialist. Many of the common off enders principally affect the central nervous system (CNS). Even those that do not will lead to a severely incapacitated state when overdosed such that the afflicted patient will require critical care in an intensive care unit (ICU). Typically, drug overdose that occurs outside of the hospital is first managed in the emergency department and then, if critical care is needed, in the medical intensive care unit. However, there are medications that are used in the neurocritical care unit (NCCU) that may lead to toxic overdose either through inadvertent provider error or because of changes in a patient's drug elimination. The most common offending medications are analgesics, antipyretics, mood stabilizers, and sedativehypnotics. Sadly, there is another circumstance in which the neurointensivist may be called on to treat patients suffering from toxic overdose: a chemical or biological terrorist act. In this situation, emergency medicine and medical critical care physicians will be quickly overwhelmed, and it is certain that the neurocritical care specialist will be called upon to assist. Thus, a discussion of the clinical management of patients suffering from exposure to the leading known chemical weapons is warranted. DRUG OVERDOSE The most common medications leading to overdose are analgesics, antipyretics, sedative hypnotics, anticonvulsants, anticoagulants, antidepressants, bronchodilators, and antiarrhythmics. All are common medications used in the NCCU.