Single-Breath-Count Test: An Important Adjunct in the Triaging of Patients in a Mass-Casualty Incident Due to Botulism

Abstract

Clostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative. The purpose of this article is to propose the adoption of the Single-Breath-Count Test (SBCT). The ease and validity of the use of the SBCT in evaluating complications associated with various neuromuscular disorders make it an attractive adjunct for triage during a mass-casualty incident due to botulism. While education, immune globulin, antitoxin, and invasive airway techniques are well-recognized steps in treating botulism, incorporating a time-honored technique such as the SBCT, will be an important addition to the triage process.

An Assessment of Nurses’ Knowledge of Botulism

“…The instrument used was a questionnaire developed by the authors based upon information available on the Centers for Disease Control and Prevention (CDC) website as well as from peer‐reviewed publications. (Arnon et al., ; Dembek, Smith, & Rusnak, ; Rega, Bork, Burkholder‐Allen, Bisesi, & Gold, ; Rega et al., ; Sobel, ; Van Rynen, Rega, Budd, & Burkholder‐Allen, ) The information was distilled into 11 multiple choice items that addressed key areas including types of botulism, pathophysiology, clinical signs and symptoms, and treatment. Demographic items about professional preparation, clinical experience, area of practice, perceived knowledge of botulism and attendance at disaster medicine classes were also included.…”

Single breath counting technique to assess pulmonary function: a systematic review and meta-analysis

“…From this, it is likely that the numeric count is impaired in individuals with lung restriction or severe airway obstruction, as both reduce lung volume in one breath [43]. This notion is supported by previous research evaluating the application of SBCT with a random marker of respiratory dysfunction in screening patients during the botulism envenomation epidemic [11], assessing respiratory decompensation in MG [48], as a screening test to segregate adult patients with chronic obstructive pulmonary disease [14,49], and to predict respiratory failure in Guillain-Barré syndrome [31]. Although the study by Quin et al [44] evaluated patients with neuromuscular diseases (Amyotrophic Lateral Sclerosis), the authors did not present correlation measures in their analysis and for this reason it was not included in the meta-analysis.…”

“…In this sense, Single Breath Counting Technique (SBCT) appears as an interesting alternative because it uses only the voice as a measurement parameter to assess lung functionality [8,9], especially in patients with infectious respiratory diseases. Another possible advantage would be its epidemiological use for screening an early pulmonary alteration, as well as monitoring the clinical evolution, and can be applied in different places, such as schools, clubs, basic health units, by teleconsultation, and even at home [10,11].…”

“…As lung function is directly related to voice production, individuals with limited lung functionality may have altered SBCT [8,[11][12][13][14]. There is evidence that this technique presents a good correlation, reproducibility [15] and accuracy [8] with the standard values of spirometry, mainly with the VC [12,13,16].…”

Correlation of peak expiratory flow rate and single breath count in normal adults

“…These alternative bedside assessment tools are inexpensive, can be easily taught, learnt and administered and are reproducible. 4 They include the cough test, wheeze test, Debono's whistle test, Snider's match blow test, breath holding time test and single breath count amongst many others. [5][6][7][8] exhalation and is measured using a simple, portable hand held flow gauge device called the peak flow meter in liter/minute (L/min).…”