Organophosphate Toxicity
Considerations
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Life threatening emergency situation
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Multisystem failure:
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Respiratory: weakness & respiratory failure, bronchospasm, hypoxemia
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Cardiovascular: hemodynamic instability
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CNS: seizures, ↓ LOC
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Decontamination/exposure to medical personnel
Treatment
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Intubation & ventilation as appropriate
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Consult toxicology, ICU
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Atropine 2-5 mg IV (often need 15-20 mg) until ↓ secretions & adequate tidal volumes
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Pralidoxime 1000-2000 mg IV, then 1000mg q12h, DO NOT give pralidoxime without atropine
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Benzodiazepines for seizures, phenytoin ineffective
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Paralysis for airway management:
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Note: succinylcholine may result in prolonged paralysis due to inhibition of acetylcholinesterase by these compounds
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↑ doses of rocuronium may be needed due to competitive inhibition at the neuromuscular junction
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