This handout is for organophosphate and carbamate poisoning. Your care team identified this based on: cholinergic toxidrome — diaphoresis, miosis, salivation, bronchorrhea, vomiting, diarrhea, fasciculations (who/ipcs; eddleston lancet 2008).
Other reasons your team may use this plan: known or suspected organophosphate/carbamate pesticide ingestion, dermal exposure, or nerve-agent attack (who/ipcs); unexplained copious secretions + bronchospasm + bradycardia + pinpoint pupils + ams cluster (eddleston lancet 2008); coma / seizure with hypersecretion and respiratory distress of unknown cause (critical-care tox review).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| skin and clothing decontamination + RPE/PPE | Remove ALL clothing (double-bag), copious soap-and-water / water irrigation of skin, eye irrigation if ocular; staff in chemical-resistant gloves/gown + respiratory protection | topical/physical | once, repeat irrigation until decontaminated | Secondary contamination of rescuers/ED staff is a real hazard — lipophilic OPs penetrate skin and off-gas; decontaminate at the door, never in a closed treatment bay (WHO/IPCS; Eddleston Lancet 2008) |
Plan: Cholinergic crisis — decontaminate → atropinize → oxime → control seizures → airway/ventilate (incl. intermediate syndrome)
Call 911 or go to the nearest emergency room right away if you have:
Watch for OPIDN delayed neuropathy (1–3 wk) and chronic neuropsychiatric sequelae; psychiatry referral if intentional self-poisoning; occupational/agricultural exposure source remediation + PPE education; outpatient neuro follow-up (WHO/IPCS; critical-care tox review)
Guideline: WHO/IPCS organophosphate management; 2024-2025 critical-care tox reviews; Eddleston Lancet OP poisoning