MEDIA REVIEWS • REVUE DES MÉDIAS The Cobra Event. R. Preston. 404 pp. the NIH genetic sequence database. 3. Schull M. Bioterrorism: when politics Random House of Canada, 1997. Before reading the book I was pretty make the best prevention [commen- $32.95. naïve about biological warfare, so much tary]. CJEM 1999;1(3):210. To think that the power of genetic code is not of this information was news to me. I being bent toward weapons is to ignore the corroborated what I could in review Pediatric Procedural Sedation and growing body of evidence, the lessons of his- articles and on the Internet, and was Analgesia. Edited by Baruch Krauss tory, and the reality of human nature. As alarmed to discover it is all true. In fact, and Robert M. Brustowicz. 327 pp. Thucydides pointed out, hope is an expen- bioterrorism is now considered to be a Lippincott Williams & Wilkins, 1999. sive commodity. It makes better sense to be prepared. potential emerging disease and is the ISBN 0-683-30558-1 — Richard Preston, 1997 subject of several papers in the journal Emerging Infectious Diseases. ediatric procedural sedation and f the bioterrorism review1–3 in this Archmedes combines gene sequences P analgesia is increasingly common I issue chilled you, The Cobra Event from a rhinovirus and Variola major in the ED; however, there is wide vari- will make you hypothermic. It is rivet- (smallpox) into a common moth virus, ability in practitioner knowledge, skill ing, well researched, and loaded with to produce the ideal biological weapon. and technique. Complications can historical and scientific detail about Given what we know of these viruses, occur, and sedation remains highly “black biology” — biological warfare. and what is possible with weaponized controversial, especially when it Like The Hot Zone, Preston’s previous agents, this story is not inconceivable. relates to children. The aim of this bestseller, The Cobra Event is part lit- Archmedes plans to release the agent in book is to help physicians deliver anal- erary journalism and part fiction. The a subway system. I was amazed to learn gesics and sedating agents in the safest subject is a bioterrorism incident that that, in 1966, the US military conducted possible fashion. seems all too possible and has direct subway tests using Bacillus subtilis. The book provides a focused review relevance to emergency medicine. They found that a closed system is an of the physiologic and pharmacological The Cobra Event describes 10 days in efficient way to disseminate airborne basis of pediatric procedural sedation. the life of Dr. Alice Austen, an officer agents, and that bacterial release at a The editors assembled a superb group of the CDC’s Epidemic Intelligence single station would infect an entire of physician authors to provide a practi- Service. A seemingly routine autopsy subway network because of air circula- cal but scientifically grounded interdis- catapults Austen into the outbreak tion induced by trains. In 1995, the rad- ciplinary and evidence-based approach. investigation of a lifetime when a ical Aum Shinrikyo sect chose the Pharmacological agents are reviewed in deranged scientist (Archmedes) at- Tokyo subway system for their deadly depth, principles and management tempts to unleash the ultimate virion. release of sarin. strategies are discussed, and guidelines Archmedes, the disgruntled ex-employ- The Cobra Event will have you on for preparation, management, monitor- ee of a genetic engineering corporation, the edge of your seat right up to the last ing and discharge of sedated patients are conducts black biology on the side. page. I highly recommend it, both as a provided. Common situations and pro- Through an escalating series of “human great escape and a source of informa- cedures are covered. For each procedure trials” he attempts to assess the effect of tion on a subject we should all know there are specific approaches, special his viral agent before implementing a more about. considerations and a decision tree. The large-scale release. book provides many clinical “pearls” Okay. I admit it sounds like “Austin Riyad B. Abu-Laban, MD aimed at the busy clinician. Powers versus Dr. Evil,” but there are a Vancouver Hospital Pediatric Procedural Sedation is a lot of gems in The Cobra Event. Preston Vancouver, BC practical reference for all physicians and deftly incorporates intriguing factual a valuable reference for any ED that information, including discussions of References deals with children and needs to establish secret US government biowarfare 1. Spence J. Bioterrorism: prevention, or update procedural sedation policies. experiments during the 1960s, biologi- preparation, or politics [introduction]. CJEM 1999;1(3):204. cal detonators, dry line source dissemi- Claude Topping, MD 2. Grafstein E, Innes G. Bioterrorism: nators, RAID (rapid assessment and ini- an emerging threat. CJEM 1999;1(3): CHA Universitaire de Québec tial detection) teams, and GenBank — 205-9. Quebec, Que. October • octobre 1999; 1 (3) CJEM • JCMU 217 Downloaded from https://www.cambridge.org/core. IP address: 170.106.35.234, on 24 Sep 2021 at 19:51:35, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1481803500004255.