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Organophosphate poisoning — SCE Acute Medicine MCQ

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HardToxicology and OverdoseOrganophosphate poisoningSCE Acute Medicine

A 46-year-old man is assessed on the acute medical unit. He is brought from a farm with salivation, bronchorrhoea, miosis, wheeze and bradycardia after pesticide exposure. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Give atropine and pralidoxime with decontamination precautions

Give atropine and pralidoxime with decontamination precautions is the best answer because cholinergic toxidrome with respiratory secretions requires atropine, oxime therapy and staff protection. Give isotonic crystalloid boluses with frequent reassessment is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Drying bronchial secretions is a key therapeutic endpoint for atropine.

Reference: Toxbase; BNF