Exposure to organophosphates (used as commercially as insecticides, and as nerve agents in wartimes) can cause symptoms such as salivation, lacrimation, urination, defecation, small pupils, sweating, muscle tremors and confusion. Onset of symptoms is usually within minutes. Primary endpoint of treatment is diminished airway secretions (lungs clear to auscultation), hypoxia improves, and dyspnea improves.
| EMR - Emergency Medical Responder
|
- Immediate decontamination as able – Clothing removal and consider attempts to rinse the patient off using water. Consult Medical Control Advise receiving hospital the type of suspected exposure and that the patient may need further decontamination.
- Initial assessment.
- Administer oxygen.
| EMT - Emergency Medical Technician Perform/Confirm All Above Interventions
|
- Administer Atropine 2.1 mg and 2-PAM (pralidoxime) 600 mg IM (single injection) by Duodote or similar autoinjector for adult and pediatric patients over 40 kg.
| AEMT – Advanced Emergency Medicine Tech Perform/Confirm All Above Interventions
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- No additional protocols at this level.
| Paramedic - Perform/Confirm All Above Interventions
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- Administer Atropine every 5 minutes (up to a total of 5 doses) until lungs are clear to auscultation.
- Adult:
- Adult Atropine dosage: 2 mg
- Follow Atropine with 2-PAM (Pralidoxime) 600 mg IM.
- Alternately provide autoinjector containing both medications in a single injection.
- Children
- Child Atropine dosage:
- 20-40 kg: 1 mg
- Less than 20 kg: 0.5 mg
- Follow Atropine with 2-PAM (Pralidoxime) 25-50 mg/kg IM
- Treat seizures with Midazolam per seizure protocol.
