Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Slide 39
Chemical Agents of Opportunity for Terrorism:
TICs & TIMs
• Mad as a hatter
• Red as a beet
• Dry as a bone
• Hot as Hare
• Blind as a bat
• Full as a flask
(Also decreased GI motility)
Clinical Effects
Module Two - The Clinical Neurotoxicology of Chemical Terrorism
39
The clinical effects produced by an anticholinergic drug or chemical can be remembered
by recalling the first letter of this alliteration/poetic mnemonic: "blind as a bat, mad as a
hatter, red as a beet, hot as a hell, dry as a bone, the bowel and bladder lose their tone,
and the heart runs alone."
The clinical effects from anticholinergic exposure include the following:
1. Altered mental status – abnormal and often bizarre behavior where the patient may
appear very agitated and often simply “delirious” or “mad.” These patients are often
profoundly altered and may exhibit bizarre movements and appear to be picking at
things. They are usually awake but often do not respond appropriately to questions and
commands. Their speech is slurred and difficult to understand and their answers often
have nothing to do with the questions asked of them. This type of delirium can be very
disabling and may last for hours even to days depending on the particular anticholinergic
compound and on the dose consumed. The “hatter” reference refers to workers who
were exposed to mercury during the production of felt hats. While mercury is not an
anticholinergic chemical, exposure to mercury could also result in an altered mental
status.
2. Red – patients appear quite flushed in appearance, almost as red as a beet
3. Dry – patients suffering from anticholinergic effects often have very dry skin and do
not perspire or sweat despite their agitation
4. Hot – because of the agitation and the inability to sweat, patients often have elevated
body temperature and fever
5. Another anticholinergic effect is the presence of dilated pupils. The pupil size is often
much larger than normal with each pupil measuring as much as 7 or 8 mm in diameter
(normal pupil diameter is 3-4 mm). The dilation of the pupils is referred to as mydriasis.
Patients with large pupils have difficulty focusing and because of their inability to focus –
they may appear “blind”
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