Template:Cholinergic Toxicity Treatment: Difference between revisions
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===Protection=== | ===Protection=== | ||
*Wear protective clothing to prevent secondary poisoning | |||
*Use neoprene or nitrile gloves (not latex) | |||
===Decontamination=== | ===Decontamination=== | ||
*Dispose of all clothes | |||
*Wash patient with soap and water | |||
===Airway=== | ===Airway=== | ||
*Suction as needed | |||
*Intubation often needed due to significant respiratory secretions / bronchospasm | |||
*Use nondepolarizing agent ([[Rocuronium]] or [[Vecuronium]]) | |||
===Breathing=== | ===Breathing=== | ||
*Use O2 100% NRB | |||
===Antidotes=== | ===Antidotes=== | ||
*'''Atropine''' | |||
**May require massive dosage (hundreds of milligrams) | |||
**Does not reverse muscle weakness due to nicotinic binding | |||
**Dosing | |||
***Adult: 1mg or more IV; repeat q5min until tracheobronchial secretions attenuate | |||
***Child: 0.01-0.04mg/kg (but never <0.1mg) IV | |||
*'''Pralidoxime''' | |||
**For Organophosphate poisoning only. | |||
**Has no use in Nicotinic poisoning | |||
**Displaces an organophosphate from acetylcholinesterase (if given early) | |||
**Dosing | |||
***Adult: 1-2gm IV over 5-10min; continuous infusion of 500mg/hr if no initial response | |||
***Child: 20-40mg/kg (up to 1gm) IV over 5-10min; 5-10mg/kg/hr if no initial response | |||
Revision as of 21:39, 21 June 2015
Protection
- Wear protective clothing to prevent secondary poisoning
- Use neoprene or nitrile gloves (not latex)
Decontamination
- Dispose of all clothes
- Wash patient with soap and water
Airway
- Suction as needed
- Intubation often needed due to significant respiratory secretions / bronchospasm
- Use nondepolarizing agent (Rocuronium or Vecuronium)
Breathing
- Use O2 100% NRB
Antidotes
- Atropine
- May require massive dosage (hundreds of milligrams)
- Does not reverse muscle weakness due to nicotinic binding
- Dosing
- Adult: 1mg or more IV; repeat q5min until tracheobronchial secretions attenuate
- Child: 0.01-0.04mg/kg (but never <0.1mg) IV
- Pralidoxime
- For Organophosphate poisoning only.
- Has no use in Nicotinic poisoning
- Displaces an organophosphate from acetylcholinesterase (if given early)
- Dosing
- Adult: 1-2gm IV over 5-10min; continuous infusion of 500mg/hr if no initial response
- Child: 20-40mg/kg (up to 1gm) IV over 5-10min; 5-10mg/kg/hr if no initial response