Organophosphates cause acetylcholinesterase inhibition, resulting in signs and symptoms such as pinpoint pupils, eye pain, sweating, drooling, tearing, vomiting, seizures, and respiratory distress. Examples of commonly used organophosphate pesticides:
- Acephate (Orthene®)
- Azinphos-methyl (Azinphos®, Guthion®)
- Chlorpyrifos (Govern®, Lorsban®, Nufos®, Warhawk®, Whirlwind®)
- Diazinon
- Dimethoate (Cygon®)
- Disulfoton (Di-syston®)
- Ethoprop (Mocap®)
- Fenamiphos (Nemacur®)
- Malathion (Fyfanon®)
- Methamidophos (Monitor®)
- Methidathion (Supracide®)
- Methyl Parathion (Penncap-M®)
- Naled (Dibrom®)
- Oxydemeton-methyl (MSR®)
- Phorate (Thimet®)
- Phosmet (Imidan®)
- Profenofos (Curacron®)
Nerve agent chemical weapons such as Sarin, Soman, Tabun, and VX are also organophosphates and should be treated accordingly.
Basic Life Support
- Initiate Hazmat Alert if indicated
- Wear protective clothing including masks, gloves, and eye protection
- Toxicity to ambulance crew may result from inhalation or topical exposure
- Remove all clothing and contain run-off of toxic chemicals when flushing
- Supplemental 100% oxygen
- Including ETCO2 level (35-45 normal)
Advanced Life Support
- Full ALS Assessment and Treatment
- If signs of severe toxicity, (severe respiratory distress, bradycardia, heavy respiratory secretions) – (do not rely on pupil constriction to diagnose or to titrate medications):
- Atropine 2 mg IV every 5 min; titrate dosing by assessing improvement in respiratory/ bronchial secretions
- For hypotension (systolic BP < 90 mmHg) not improved by fluid boluses, or when fluid\ boluses are contraindicated:
- Norepinephrine infusion at 0.5-16 mcg/minute IV/IO, titrated to maintain SBP > 90 mm Hg (see pg. 10-27 for infusion preparation chart) OR
- Push dose epinephrine: Remove 9ml (0.9mg) of 1:10,000 Epinephrine from the pre-filled syringe then draw 9ml of NS into the pre-filled syringe and mix solution. Concentration 10mcg/ml. IV push 1ml every minute to increase blood pressure to 90 mmHg; max 10ml (100mcg).
- If any of the following conditions occur, refer to the appropriate protocols:
- Altered Mental Status
- Seizures