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Organophosphate exposure — DipIMC MCQ

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HardEnvironmental MedicineOrganophosphate exposureDipIMC

After protected rescue from an enclosed pesticide exposure, a patient has bronchorrhoea, wheeze, salivation, bradycardia, pinpoint pupils and fasciculations. Airway support and decontamination are underway. How should atropine be used?

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Correct answer: E — Repeat atropine to clear secretions and restore effective cardiorespiratory signs

The best answer is “Repeat atropine to clear secretions and restore effective cardiorespiratory signs”. This is a cholinergic toxidrome from organophosphate exposure. UK chemical-incident guidance uses repeated atropine until secretions are minimal, the lungs are clear and heart rate and blood pressure are adequate. Pupil size is not a reliable endpoint and oxime treatment does not replace atropinisation. Neuromuscular features may persist even after clinically important muscarinic effects improve.

Reference: UKHSA, Chemical, biological, radiological and nuclear incidents handbook: https://www.gov.uk/government/publications/chemical-biological-radiological-and-nuclear-incidents-recognise-and-respond