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Organophosphate poisoning — RCPSC EM MCQ

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HardToxicologyOrganophosphate poisoningRCPSC EM

A farm worker has diaphoresis, bronchorrhoea, wheeze, vomiting, miosis, bradycardia and fasciculations after pesticide exposure. What is the most appropriate immediate management?

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Correct answer: B — Decontaminate, give atropine, then give pralidoxime

The best answer is “Decontaminate, give atropine, then give pralidoxime”. This is severe cholinergic poisoning. Contamination control and airway support are immediate priorities; atropine is titrated to drying of bronchial secretions and adequate ventilation, while pralidoxime is used for organophosphate exposure with poison-centre guidance. A beta-blocker worsens the physiology and charcoal alone cannot control respiratory failure.

Reference: Ontario Poison Centre: Organophosphates and carbamates: https://www.ontariopoisoncentre.ca/siteassets/pdfs/english/protocols/organophosphates-and-carbamates_4-pages.pdf