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Maia Dorsett

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date: 24 September 2021

This case illustrates the priorities of management in a patient with acute organophosphate toxicity in the prehospital environment. Organophosphates are common components of pesticides. They act as toxins and can lead to development of the cholinergic toxidrome by blocking breakdown of the neurotransmitter acetylcholine at nerve endings. The cholinergic toxidrome is a clinical syndrome marked by parasympathetic excess (bradycardia, bronchorrhea, bronchospasm, miosis, lacrimation, salivation, urination, and defecation), neuromuscular junction activation (muscle fasciculations), and central nervous system toxicity (delirium and seizures). The priorities of care in organophosphate exposure include rapid administration of antidote (atropine and pralidoxime), airway management, and patient decontamination to prevent further toxin absorption. Medical providers must always protect themselves in the case of toxic exposure and should wear double nitrile gloves at all times when handling the patient or their clothing.

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