Organophosphate poisoning; remove clothing or give atropine! - USMLE Forums
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Old 03-27-2012
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Poison Organophosphate poisoning; remove clothing or give atropine!

Nerve gas and Organophosphates(pesticides) poisoning can be absorbed through the skin.
If a patient with salivation, vomiting, sweating, urination, loose stools and shortness of breath is arrived to ER, what would be the first step?
a) administer atropine
OR
b) remove all the clothing and wash the body
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  #2  
Old 03-27-2012
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Default b

the answer is b because from the clothes the poison is still being absorbed continuously and thus the continuous exposure should be stopped first.
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i am in agreement; first step is to get patient out of those clothes because of the fact that the poison can be absorbed through the skin plus you as a health care professional may be exposed if they weren't taken off; then administering atropine comes next.
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Old 03-27-2012
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if u guys have MTB, plz check Emergency medicine chapter page 540....Thanks!
It said Atropine first and removing the clothes & washing the patient will do nothing for symptoms that are already occurring.
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Old 03-30-2012
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I will wear gloves first.
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Old 03-30-2012
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Quote:
Originally Posted by tdoubleun View Post
if u guys have MTB, plz check Emergency medicine chapter page 540....Thanks!
It said Atropine first and removing the clothes & washing the patient will do nothing for symptoms that are already occurring.
yeah..both mtb2 and mtb3 recommend atropine first ..however they taught me in med school that removal of contaminated clothes should be done first..damn i feel so helpless when theres no clear cut answer..however i think the que stem in exam will mention one of the 2 above options and we'll just have to select the other one for the answer.. lets pray dat happens :sorry:
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Quote:
Originally Posted by iceman_purav View Post
yeah..both mtb2 and mtb3 recommend atropine first ..however they taught me in med school that removal of contaminated clothes should be done first..damn i feel so helpless when theres no clear cut answer..however i think the que stem in exam will mention one of the 2 above options and we'll just have to select the other one for the answer.. lets pray dat happens :sorry:
It makes sense giving atropine first since it hardly takes any time to give it and it not only treats the organophosphates already in the system but the organophosphates being currently absorbed from the contaminated clothes. Also, removing the contaminated clothes takes longer (unless you got a stripper!). In real life both happens simultaneously but I'll glove & gown first before touching the patient (if that's an answer choice).
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Old 03-30-2012
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Correct Answer

Quote:
Originally Posted by iceman_purav View Post
yeah..both mtb2 and mtb3 recommend atropine first ..however they taught me in med school that removal of contaminated clothes should be done first..damn i feel so helpless when theres no clear cut answer..however i think the que stem in exam will mention one of the 2 above options and we'll just have to select the other one for the answer.. lets pray dat happens :sorry:
Although Master the Boards likes Atropine first, there is a question in U World Q bank, medicine, poisoning section about Organophosphate poisoning which gives the answer of removing the contaminated clothes first.
MTB is writing a totally different concept from u world.
thanks
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Old 03-30-2012
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Correct Answer

Quote:
Originally Posted by Novobiocin View Post
It makes sense giving atropine first since it hardly takes any time to give it and it not only treats the organophosphates already in the system but the organophosphates being currently absorbed from the contaminated clothes. Also, removing the contaminated clothes takes longer (unless you got a stripper!). In real life both happens simultaneously but I'll glove & gown first before touching the patient (if that's an answer choice).
Unfortunately, there is no answer like "put on the Gloves first". In real situation, we can do simultaneously as u said. But not in step2 CK
Anyway, thanks for your input.
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