organophostphate poisoning

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Bevo

Radiology, R1
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I've heard 3 different things now for the patient who comes in with organophosphate poisoning.

1) Kaplan tells me A) Admin Atropine b) remove clothings c) give pralodoximine ( I believe b and c are in the right order)

2) NMS question book says A) give Pralodoximine first, then remove clothing

3) UW says A) remove clothing B) then atropine

Which is it?
 
Bevo said:
I've heard 3 different things now for the patient who comes in with organophosphate poisoning.

1) Kaplan tells me A) Admin Atropine b) remove clothings c) give pralodoximine ( I believe b and c are in the right order)

2) NMS question book says A) give Pralodoximine first, then remove clothing

3) UW says A) remove clothing B) then atropine

Which is it?



Im so sick of this happening... I keep getting totally contradicting info on UW B&W and especially Secrets

I think on the real exam there will be only 1 of those choices listed as opposed to the UW questions where you have to pick the best answer out of all the correct answers... At least that was my experience on step 1 after doing Q bank


But to answer your question I think removing the clothing is the first thing to do (ABCDE=Exposure) cause it gets absorbed through the skin
 
LordSoulsby said:
the kaplan answer is correct... administer atropine first, then worry about the clothes
How do you figure that? or should i just take your word for it professor?
 
Wrong! Administering atropine to a kid soaked in pesticide won't do anything. 😡
 
well, I was told first to give Atropine because it will act quicker. Then after you give the atropine, you get the clothing off and what not. Then you can give the pralodoxmine.
 
Bevo said:
well, I was told first to give Atropine because it will act quicker. Then after you give the atropine, you get the clothing off and what not. Then you can give the pralodoxmine.

For Step 2 I am pretty sure the answer is just PAM.


I mean the cooking spray, not pralidoxime. Trst me.
 
emedicine.com

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.
 
Belive you should remove clothing first. In all first aid and emergency care I read first thing is to remove the source of danger, atropine won't do you any good if the posion in being absorbed vis clothes.
 
data297 said:
Belive you should remove clothing first. In all first aid and emergency care I read first thing is to remove the source of danger, atropine won't do you any good if the posion in being absorbed vis clothes.


9 times out of 10, Step 2 will list "remove clothing" or "PAM" but not both.

In other words, they'll make it easy for you.
 
Definitely remove the clothing first THEN give the atropine...I have seen this question 3 times in various question books/banks and that has always been the right answer
 
Hopefulmeds said:
Definitely remove the clothing first THEN give the atropine...I have seen this question 3 times in various question books/banks and that has always been the right answer

which 3 sources gave the same answer(s)?

according to Bevo...

1) Kaplan tells me A) Admin Atropine b) remove clothings c) give pralodoximine ( I believe b and c are in the right order)

2) NMS question book says A) give Pralodoximine first, then remove clothing

3) UW says A) remove clothing B) then atropine
 
FarEastGrapplr2 said:
which 3 sources gave the same answer(s)?

according to Bevo...

1) Kaplan tells me A) Admin Atropine b) remove clothings c) give pralodoximine ( I believe b and c are in the right order)

2) NMS question book says A) give Pralodoximine first, then remove clothing

3) UW says A) remove clothing B) then atropine

It really depends where you are:

If "on the scene" then give the IM injection first...

If in a hospital ER then take cloths off and wash off since these decontamination facilities are assumed to be available...

Thats my 2 cents...
 
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