injuries poisoning
Organophosphate Poisoning and Carbamate Poisoning
Treatment
Supportive therapy Atropinefor respiratory manifestations Decontamination Pralidoximefor neuromuscular manifestations Supportive therapy is key. Patients should be closely monitored for respiratory failure due to weakness of respiratory muscles. Atropineis given in amounts sufficient to relieve bronchospasm and bronchorrhea rather than to normalize pupil size or heart rate. Initial dosage is 2 to 5 mg IV (0.05 mg/kg in children); the dose can be doubled every 3 to 5 minutes as needed. Grams ofatropinemay be necessary for severely poisoned patients. Decontaminationis pursued as soon as possible after stabilization. Caregivers should avoid self-contamination while providing care. For topical exposure, clothes are removed, and the body surface is flushed thoroughly. For ingestion within 1 hour of presentation, activatedcharcoalcan be used. Gastric emptying is usually avoided. If done, the trachea is intubated beforehand to prevent aspiration. Pralidoxime(2-PAM) is given afteratropineto relieve neuromuscular symptoms. 2-PAM (1 to 2 g in adults; 20 to 40 mg/kg in children) is given over 15 to 30 minutes IV after exposure to an organophosphate or carbamate because, frequently, whether the poison is an organophosphate or carbamate is unknown at the time of treatment. An infusion can be used after the bolus (8 mg/kg/h in adults; 10 to 20 mg/kg/h in children). Benzodiazepinesare used for seizures. Prophylacticdiazepammay help prevent neurocognitive sequelae after moderate to severe organophosphate poisoning. has been recommended for people exposed to a Nerve Chemical-Warfare Agents . 