Template:Cholinergic Toxicity Treatment: Difference between revisions
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===Antidotes=== | ===Antidotes=== | ||
*Dosing with atropine and pralidoxime are time dependent and provides ability to reverse symptoms while awaiting agent metabolism | *Dosing with atropine and pralidoxime are time dependent and provides ability to reverse symptoms while awaiting agent metabolism | ||
*For exposure to nerve agents, manufactured IM autoinjectors are available for rapid administration: | |||
**Mark 1 | |||
***Contains 2 separate cartridges: atropine 2 mg + 2-PAM 600 mg | |||
***Being phased out with newer kits | |||
**DuoDate | |||
***Single autoinjector containing both medications | |||
<ref> Walls, R.M., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders. </ref> | |||
==Antidotes== | ==Antidotes== | ||
Revision as of 20:44, 25 February 2018
Decontamination
- Providers should wear appropriate PPE during decontamination.
- Neoprene or nitrile gloves and gown (latex and vinyl are ineffective)
- Dispose of all clothes in biohazard container
- Wash patient with soap and water
Supportive Care
- IVF, O2, Monitor
- Aggressive airway management is of utmost importance.
- Intubation often needed due to significant respiratory secretions / bronchospasm.
- Use nondepolarizing agent (Rocuronium or Vecuronium).
Antidotes
- Dosing with atropine and pralidoxime are time dependent and provides ability to reverse symptoms while awaiting agent metabolism
- For exposure to nerve agents, manufactured IM autoinjectors are available for rapid administration:
- Mark 1
- Contains 2 separate cartridges: atropine 2 mg + 2-PAM 600 mg
- Being phased out with newer kits
- DuoDate
- Single autoinjector containing both medications
- Mark 1
Antidotes
Atropine
- Competitively blocks muscarinic sites (does nothing for nicotinic-related muscle paralysis)
- May require massive dosage (hundreds of milligrams)
- Dosing[2]
- Adult: Initial bolus of 2-6mg IV; titrate by doubling dose q5-30m until tracheobronchial secretions controlled
- Once secretions controlled → start IV gtt 0.02-0.08 mg/kg/hr
- Child: 0.05-0.1mg/kg (at least 0.1mg) IV; repeat bolus q2-30m until tracheobronchial secretions controlled
- Once secretions controlled → start IV gtt 0.025 mg/kg/hr
Pralidoxime
- AKA 2-PAM
- For Organophosphate poisoning only - reactivates AChE by removing phosphate group → oxime-OP complex then excreted by kidneys.
- This must be done before "aging" occurs - conformational change that makes OP bond to AChE irreversible.
- Dosing[2]
- Adult: 1-2gm IV over 15-30min; repeat in 1 hour if needed or 50 mg/hr infusion.
- Child: 20-40mg/kg IV over 20min; repeat in 1 hour if needed or 10-20 mg/kg/hr infusion.
- ↑ Walls, R.M., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.
- ↑ 2.0 2.1 Agency for Toxic Substances and Disease Registry, Case Studies in Environmental Medicine, Cholinesterase Inhibitors: Including Pesticides and Chemical Warfare Nerve Agents. Centers for Disease Control (CDC). PDF Accessed 06/21/15