Organophosphate Poisoning

Question 1

Organophosphates poisoning pathophysiology

Answer 1

Found in pesticides, herbicides, and nerve gas which inhibit anticholenesterase enzymes, increasing the concentration of acetylcholine, leading to cholinergic symptoms (parasympathetic overdrive).
Muscarinic and nicotinic receptors are effected.

Question 2

Clinical features of muscarinic excess

Answer 2

DUMBBELS:
Diarrhoea
Urination
Miosis
Bradycardia
Bronchospasm
Emesis
Lacrimation
Salivation
Hypotensive (late sign)

Question 3

Clinical features of nicotinic excess

Answer 3

Fasciculations
Tremor
Muscle weakness
Respiratory muscle paralysis

Question 4

Central clinical features of organophosphate poisoning

Answer 4

Agitation
Seizures
coma

Question 5

Excessive cholinergic effects

Answer 5

Salvation
Bronchospasm
Sweating
Nausea
Bradycardia

Question 6

Organophosphate poisoning Management

Answer 6

• PPE!
• Pt decontamination
• Confirm evidence of suspected poisoning: cholinergic effects; looking for label with anticholinesterase
  PLUS
• Evidence of excessive cholinergic effects: salivation compromising airway or bronchospasm AND/OR bradycardia with inadequate perfusion.
• No excessive cholinergic effects: monitor and transport.
• Excessive cholinergic effects: ICP - atropine 1.2mg (20mcg/kg paed) IV repeated at 5 min intervals until symptoms resolve.