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Old 04-28-2013
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Poison Organophosphate Phosphate Immediate Treatment?

Basically the question as what is the most appropiate immediate treatment
(2 yr old girl is brought ot the ED 20 mins after she ingested insecticide. she is moderate respiratory distress. Her respiration are 18 and shallow. pulse oximetry on room is 82%. P/E oral secretion. in addition to securing the airway, the most apporpiate tx?)

a) atropine
b) bendryl
c) -stigme
D) pralidoxime
e) Succinylcholine....

If anyone could first explain why do we need to know this for step 1. The 1st step in management isn't that step2??
and second.. i know the answer is atropine+ 2PAM.

I picked 2PAM. Cause i remembered something about, having half life, and aging from kaplan guy. and i got it wrong... some please explain, why would atropine be more likely??
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Old 04-28-2013
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Well you have to give Atropine first because you need to stop the leakage caused by insecticides. Later, you give 2 PAM to regenerate AChE molecules; because insecticides basically inhibits AChE so that excess ACh won't breakdown.
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Old 04-29-2013
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organophosphates irreversibly! inhibits the AChE => excess ACh stimulating both the M and N receptors. The most crucial is to stop the overstimulation of the M receptors because they are causing life-threatening consequences ( bronchocontriction and bradycardia). That's why you give atropine. However atropine has no effect on the N receptors which control skeletal muscle excitability => still at risk for muscle paralysis. And that's the reason you also give pralidoxime, which regenerates AChE.
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Pharmacology-, Step-1-Questions, Toxicology-

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