#this is not an Adler design involving a lot of risk taking it’s just that I’ve only drawn him once before this and now I’m not happy | Explore Tumblr Posts and Blogs

macgyvermedical · 5 years

Text

3-Quinuclidinyl Benzilate is My New Favorite Chemical Weapon, A “Mason+Cable+Choices” Medical Review

This episode. This freaking episode.

First of all, Charlie Robinson, who I really thought was going to stick around in this version of the series after he survived his first episode, had to go and become the instrument to someone else’s revenge scheme. We also got to see a relatively hard side of Mac in the interrogation room, and I’m not sure whether to applaud it as character development or feel like they’re going too dark.

From a medical and whump standpoint, this episode sure has a lot of things covered- the gunshot wound, the neck needle, the 3-quinuclidinyl benzilate poisoning (Yay!), the heart needle/antidote, and the toxic smoke. I'm warning you now, most of this review is about the 3-quinuclidinyl benzilate poisoning.

The Gunshot Wound

Honestly, there’s not a lot to be said about the gunshot wound- it was to the outside of Charlie’s thigh, so while it would have been painful and probably would have bled some (the duct tape wouldn’t have helped stop the bleeding) it probably wouldn’t have been enough to really threaten his life. If he hadn’t later plummeted to his death, he might have needed some antibiotics, professional medical attention, and physical therapy.

Neck Needles

Neck needles aren’t a thing, but I’ve talked about those in previous posts.

3-Quinuclidinyl Benzilate Poisoning

Oh hey look, we’re already at 3-quinuclidinyl benzilate poisoning! And fam? this is where I really did my research.

If you’ve been on this blog long enough you know I like my chemical weapons. Not in a “kill everyone” way but in more of a “strong academic interest I may one day write a thesis about” way. And man, do I love having access to an academic library again. Whoo buddy. This was fun.

In the episode, Mason uses a chemical weapon called 3-quinuclidinyl benzilate (also noted in the episode as “BZ”), smuggled in a false tooth, to subdue Mac before making his escape from the interrogation room. The tooth contains QNB in an aerosol form, which when released forms a visible cloud in the room. Mac breathes the aerosol, which appears to instantly paralyze or possibly sedate him, while Mason takes advantage of the small amount of uncontaminated air in Mac’s water bottle before making his escape up the air vent. A security team makes their way to Mac, Desi calls for a med team, and Mac is revived with an antidote delivered by a needle straight to his heart.

When someone mentions chemical weapons, most people think of mustard gas or nerve agents. But poisons designed to torture and kill people aren’t the only things that fall into the category of chemical weapons. In fact, there’s a whole class of them, called “incapacitants” that are specifically designed to take people out of commission without a high risk of death or permanent disability.

Let me just say, Jim Adler is a writer after my own heart. He wrote both this episode and “Mac+Fallout+Jack” and considering both were absolutely gut-wrenching and contained reasonable choices of incapacitating agents, I really, really appreciate what he’s done for the canon. He didn’t get everything right here (*cough cough* neck and heart needles *cough cough*), but he clearly understands enough about drugging people to buy some literary license. Not all of it, but some.

Now, as I’ve talked about in other posts, drugging people into unconsciousness isn’t a particularly safe thing to do. Unconscious people can’t protect their airway, and most drugs that render people unconscious significantly impact their respiratory rate, blood pressure, or both. Unless the party doing the drugging is prepared to devote at least one trained person to monitoring and management of the drugged individual, there’s a chance that person could suffocate and die. Paralytic agents have a lot of the same issues.

This becomes even more problematic if you’re trying to incapacitate multiple people. Case in point- in 2002 a small group of Chechan rebels held over a 1,000 Russian civilians hostage in a theater in Moscow. After several days, in order to end the stand-off, Russian military personnel used what was probably an aerosalized opioid* to render everyone in the building unconscious. They then stormed the building and rescued the hostages. Unfortunately, even though antidotes were available and used, about 1 out of every 10 hostages ended up dying due to the mass drugging, which didn’t win any PR points for the use of incapacitating agents.

But if you get just slightly more creative, sedation and paralysis are not the only two ways to drug enemy combatants into uselessness. Turns out, a variety of hallucinogens and deliriants can achieve the same goal without the same risk of death by suffocation. If you can get someone to a state where they can’t remember what they’re doing or perform basic skills like reading or decision making, they can’t easily attack and kill your own personnel.

This is where 3-quinuclidinyl benzilate, (NATO code BZ, US Army code EA-2277, Soviet code Substance 78, and usually referred to as “QNB” in medical circles) starts to stand out. QNB is a deliriant and hallucinogen. Now, there are lots of drugs that fall into these categories- think LSD, ketamine, PCP, and atropine to name a few. QNB works very similarly to atropine, by selectively blocking the action of the neurotransmitter acetylcholine (think the opposite of a nerve agent), but with significantly more of its action concentrated around the mind-altering side-effects. It’s also safer, hardier, more versatile, and has a more ideal onset and duration of action.

The typical course of incapacitation with QNB involves:

An initial period of progressively worsening anxiety, restlessness, and confusion

A period of extreme drowsiness

Finally, more confusion, an inability to perform simple tasks, difficulty with movement, hallucinations, and bizarre behaviors including picking at things, which all gradually wane over the course of 2-4 days.

Here are some reasons QNB stands out as a particularly effective incapacitant (and all the ways the episode ignored them):

The first is therapeutic index. A drug’s therapeutic index is the difference between its effective dose and it’s toxic dose. If we say a drug has a “narrow” therapeutic index, that means there’s a very small difference between an effective dose and a toxic one, while a “wide” therapeutic index means that the two doses are very different. When drugging someone without their knowledge, no matter how you’re delivering the drug, it’s really hard to estimate the actual ingested dose. Because of this, you want the widest possible range of effective-but-not-deadly doses you can have- the best drugs for mass druggings are those with the widest possible therapeutic indices.

QNB happens to have a very wide therapeutic index compared to other possibilities for incapacitants. The lowest effective dose is about 150 micrograms, while a toxic dose is more than 650 times that at about 100 miligrams. In small doses, the drug doesn’t last as long and causes more sedating vs delirious effect, but is still very useful in lowering the effectiveness of an enemy force.

The second is its options for route and availability in an environment. How any drug is given is referred to the route of administration. These can include:

PO (oral- taken as a pill or liquid)

IV (intravenous- injected into a vein)

IM (intramuscular- injected into a muscle)

SC (subcutaneous- injected into fat)

IO (intrasseous- injected into a bone in an emergency)

Inhaled (breathed and absorbed through blood vessels in the lungs)

PR (rectal- given rectally)

Transdermal (absorbed through the skin)

Most drugs work best when administered a certain way, and some may only be produced for use by a certain route. Some, like ketamine or LSD, can’t be absorbed in the stomach, so giving them orally doesn’t work (LSD “tabs” are actually absorbed through the mucous membrane in the mouth). QNB’s advantage is that it can be given by any route. You want to drug food or drink? It works. Aerosolize it and pump it into the air? Also works. Inject it IM, SC, or IV? Yes but you might have to answer some questions. Coat something like a doorknob? It goes through skin too!

QNB is particularly suited as an aerosol, not because it readily evaporates, but because it’s odorless. No one would even know they were breathing it until it started working, and even then, they might not know what happened. It also stays in the environment for a long time- up to several weeks depending on conditions- and can survive extreme heat without degrading, so it could be disbursed via explosive (LSD would not survive). Bottom line, everyone that came into that room to rescue Mac was contaminated, probably enough to cause them problems. Also, so was Mason, so take that as you will.

The third is the drug’s onset and duration of action. In the episode Mac is almost instantly incapacitated when the spray hits his face. This is not how any drug works (even via the IV route, the quickest-onset drugs still take at least 15-30 seconds to be felt), but particularly not QNB. QNB has an onset time of about an hour, no matter the route. This is actually beneficial to the drug’s original purpose- if no one shows symptoms from drugging with an odorless aerosol until an hour after exposure, there’s no way to take protective measures. Suddenly everyone’s hallucinating and can’t do basic math. Sucks for that attack plan you were working on.

The fourth and final benefit that QNB provides is both it’s lack of (specific) antidote and the fact that there are no lasting effects. Some people point to physostigmine as a possible antidote, but it’s not perfect and has some incapacitating side effects of its own. As incapacitation with QNB is generally not life threatening, it’s probably better for most people to be cared for in a safe place and ride out the effects. Since it’s also not a carcinogen or mutagen, once the effects subside, there shouldn’t be any additional problems.

Phew. Okay.

Heart Needles

I swear I’ve talked about heart needles before, but I’ll do it again since it hasn’t been recently. In the episode, Mac is injected with an antidote directly into his heart. Now, like we said before, using an antidote wouldn’t really help him much, and its not really necessary. He’s just gonna have to ride it out (I don’t make the rules...).

But they chose to do it, so we should talk about it- in the pre-CPR era, intracardiac injections represented the only way of getting emergency medications like epi to the heart in the case of cardiac arrest. As late as 1992, there were still some groups advocating for it if the patient was in asystole (flatline) and IV or IO access couldn’t be obtained. Mac has excellent veins if I do say so myself, and he also wasn’t coding, so there’s no reason for this to have been a thing in the episode. It’s also never used today.

Also, I’m going to be particularly disappointed if that was just a callback to the similarly inaccurate Pulp Fiction scene. Because this show has already used epi to counter an acetylcholine-based problem, and you already only get to do that once. EPINEPHRINE IS NOT AN ALL-PURPOSE ANTIDOTE.

Jim Adler based on your other work I have to assume you know better.

Also it’s late and I’m not talking about the toxic smoke. See my many posts on cyanide and some time in the future come read my post on carbon monoxide.

*According to the book Chemical Warfare: Secrets Almost Forgotten by James Ketchum, who did a lot of the initial research on chemical incapacitants. Other sources reference the drug used as anything from traditional nerve agents to QNB itself, but the onset times and symptoms initially reported seem to match up better with an opioid than QNB.

R E F E R E N C E S

Awl - X-Ray + Penny - Duct Tape + Jack - CD + Hoagie Foil - Guts + Fuel + Hope - Wilderness + Training + Survival - Father + Bride + Betrayal - Lidar + Rogues + Duty - Nightmares - Seeds + Permafrost + Feather - Friends + Enemies + Border -

#MacGyver #mason+cable+choices #chemical weapons #neck needles #heart needles

53 notes · View notes