S15C195 - Pesticides

Question 1

Organophosphate: pathophys

Answer 1

• acetylcholinesterase inhibitor
• leads to incr acetylcholine accumulation at synapses and NMJ, causing initial overstimulation of acetylcholine receptors
• cholinergic crisis ensues

Question 2

Organophosphate poisoning: Sx

Answer 2

SLUDGE / DUMBELS
Salivation, Lacrimation, Urinary incontinence, Defecation, GI pain, Emesis

Defecation, Urination, Muscle weakness, Miosis, Bradycardia, bronchorrhe, bronchospasm, Emesis, Lacrimation, Salivation

Killer B’s (brady, bronchorrhea, bronchospasm)

-long QT, AV block

Question 3

Organophosphate poisoning: Tx

Answer 3

• A - use a non-depolarizing agent
• BC
• D - PPE, no benefit to AC, lavage
• E - no benefit of HD
• F - pralidoxime, atropine repeated q5min until symptoms subside
• give benzos for Sz

Question 4

Paraquat

Answer 4

• hospitalize if any exposure
• caustic: corneal injury, pulm edema, epistaxis, hemoptysis, pulm injury
• mortality 75% (from pulmonary fibrosis)

Question 5

Anticholinergics (effects 6)

Answer 5

• eg. atropine, hyoscyamine, scopolamine, belladonna
• ddx: encephalitis, reye syndrome, head trauma, NMS
• effects: dry as a bone, red as a beet, hot as hare, blind as a bat, mad as a hatter, stuffed as a pipe
• sinus tachy, mydriasis

-tx:
charcoal
benzo’s (for hyperthermia)
physostigmine (cholinesterase inhibitor)(for severe agitation, avoid if cardiac conduction abnormalities)
NaHCO3 for wide complex tachy (avoid class IA antiarr)

Question 6

Benadryl (diphenhydramine) OD

Answer 6

-severe symptoms if >1000mg ingested or 7.5mg/kg in children