8-09 organophos poison.doc

Washtenaw/Livingston MCA

Hazardous Materials Medical Response Team Procedures Organophosphate Poisoning
FORMS: Liquids, solids (dusts, wettable powders) and aerosols. ROUTES OF EXPOSURE: Skin and eye, inhalation, ingestion, skin absorption SIGNS AND SYMPTOMS: Cardiovascular:
Bradycardia, ventricular arrhythmias, A-V blocks and hypotension
Respiratory:
Respiratory failure, prominent wheezing, acute pulmonary edema, bronchial secretions, Gastrointestinal: Nausea/vomiting/diarrhea, abdominal cramps, excessive salivation, urination and defecation.
Lacrimation, blurred vision and constricted pupils. Pale, cyanotic skin with excessive diaphoresis. SLUDGE (salivation, lacrimation, urination, defecation, G.I. pain and emesis) syndrome.
Procedure:
Follow General HazMat Treatment Protocol. If ingested, administer Activated Charcoal 30-100 G as a Oral tracheal or nasal tracheal intubation is indicated in the unconscious or respiratory arrest patient. Start an IV of Lactated Ringers TKO. Use fluid resuscitation cautiously to treat hypotension if signs of hypotension are present. WATCH FOR SIGNS OF
PULMONARY EDEMA!
In general, cardiac dysrhythmias and seizures can be Lasix is not effective in treating pulmonary edema!
DO NOT TREAT IF ASYMPTOMATIC!
Washtenaw/Livingston MCA
Organophosphate Poisoning

In general, Atropine therapy is indicated if one or more of the following signs are present:
Altered mental status or seizures Nausea/vomiting/diarrhea or abdominal cramps Pupillary constriction Salivation Diaphoresis Respiratory distress, wheezing, pulmonary edema Significant arrhythmia (particularly bradycardia) Other medical conditions may cause these symptoms and should be ruled out first. In the symptomatic patient with significant exposure administer treatment in the following order: If there is no improvement the treatment can be 0.5 to 1 g in adults or 10 to 25 mg/kg in children. Max. If no effect (which helps confirm the diagnosis) the dose may be doubled q10 minutes until SLUDGE symptoms are relieved. The goal of Atropine therapy is to clear bronchial spasms. There is no max. dose in Organophosphate
Poisoning.
Pupillary dilation is an early response and can=t be used to guide therapy. Tachycardia is not a contraindication to Atropine therapy and may actually lessen as the hypoxia resolves with drying up of the secretions and clearing of the bronchospasm. The patient must be observed carefully for ventricular arrhythmias secondary to hypoxia, especially when administering atropine. In massive organophosphate overdoses huge amounts of atropine may be needed. Seizures are generally relieved after atropinization. If not, follow Protocol 5-11. SPECIAL CONSIDERATIONS:
In cases of skin absorption atropine ma not reverse respiratory paralysis. Do not give aminophylline, morphine or furosemide!

Source: http://www.livgov.com/ems/Documents/protocols/Haz-Mat%20Medical%20Response%20Team/organophosphatePoisoning.pdf