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Medical Care: Secure the patient's airway. Intubation might be necessary in cases of respiratory distress from laryngospasm, bronchospasm, or severe bronchorrhea. Monitor neck muscle weakness, respiratory rate, arterial blood gas, and mental status regularly to assess progression or decompensation. The tidal volume initiated by the patient can be used as a measure of disease severity in patients who are intubated.
Withhold administration of atropine until a cardiac monitor and a defibrillator are in place and until the patient's airway is secured. Atropine can precipitate ventricular fibrillation in hypoxic patients.
Continuous cardiac monitoring and an ECG are necessary. Electrical pacing is the treatment of choice for ventricular tachycardia associated with a prolonged QTc. Atropine can reverse some cardiac manifestations. Electrolyte abnormalities might cause dysrhythmias.
Strip and gently cleanse patients with suspected OP exposure with soap and water because OPs are hydrolyzed readily in aqueous solutions with a high pH. Consider clothing hazardous waste and discard accordingly. Ethyl alcohol has been used to wash intact skin to prevent further absorption of the OP compound through the skin.
Healthcare providers must avoid contaminating themselves while handling patients. Use personal protective equipment, such as neoprene or nitrile gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory protection when decontaminating patients.
Irrigate the eyes of patients with ocular exposures using isotonic sodium chloride solution or lactated Ringer's solution. Morgan lenses can be used for eye irrigation.
Activated charcoal (0.5-1 g q4h) is used for gastric decontamination. Sorbitol can be used; however, many patients have increased GI motility following OP poisoning.
