Acetylcholinesterase Inhibitors (Carbamates, Nerve Agents, Organophosphates) Exposure

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Fluids and medications titrated to maintain SBP > 70 + (age x 2) mmHg 

□ Consider calling poison control early 		□ Altered mental status
□ Nausea/vomiting/diarrhea
□ Pupil changes
□ Tachycardia/bradycardia
□ Tachypnea/bradypnea/apnea
□ Seizures
□ Burns		□ Sepsis
□ Suicidal ideation
□ Heat illness
□ Cold illness
□ DKA

Clinical Management Options

EMT-B
• Place in position of comfort
• Oxygen target SpO2 92% – 96%  
• Obtain blood glucose level
• Consider contacting poison control at 1-800-222-1222
Paramedic
• IV / IO access as appropriate for patient condition 
• IV fluid therapy with Isotonic Crystalloid, titrated to Adult SBP > 100 mmHg      
• Consider Push dose Epinephrine IV/IO for hypotension 
• Consider Atropine for patients with bradycardia, difficulty breathing and seizures
• Monitor ETCO2 in patients with respiratory distress
• Consider ECG 
• Provide antidotes when available 
Consult Online Medical Control as Needed

Pearls

  • Frequent re-evaluations are required as patients can deteriorate rapidly.
  • Identify amount and timing of any ingestions when possible. Take pill bottles if available.
  • Reduce the risk of exposure to you and those around you and perform rapid decontamination on scene if necessary.
  • Consider contacting poison control early to guide treatment options
  • Provide antidotes early when possible