AtroPen Auto-Injector (atropine sulfate injection).ATNAA Antidote Treatment – Nerve Agent, Auto-Injector (atropine injection and pralidoxime chloride injection).Products for Nerve Agent and Insecticide Poisoning Nithiodote (sodium nitrite injection USP and sodium thiosulfate injection USP for intravenous infusion).Start with 1-2 g (20-40 mg/kg) IV in 100 mL isotonic sodium chloride over 15-30 min repeat in 1 h if muscle weakness is not relieved then repeat q3-8h if signs of poisoning recur other dosing regimens have been used, including continuous drip. Because it does not significantly relieve depression of respiratory center or decrease muscarinic effects of AChE poisoning, administer atropine concomitantly to block these effects of OP poisoning. Current recommendation is administration within 48 h of OP poisoning. Used as an antidote to reverse muscle paralysis resulting from OP AChE pesticide poisoning but is not effective once the OP compound has bound AChE irreversibly (aged). Pralidoxime– Nucleophilic agent that reactivates the phosphorylated AChE by binding to the OP molecule.An atropine drip titrated to the above endpoints can be initiated until the patient’s condition is stabilized. Consider doubling each subsequent dose for rapid control of patients in severe respiratory distress. Start with a 1-2 mg IV bolus, repeat q3-5min prn for desire effects (drying of pulmonary secretions and adequate oxygenation). The main concern with OP toxicity is respiratory failure from excessive airway secretions. Tachycardia and mydriasis must notbe used to limit or to stop subsequent doses of atropine. Atropine – The endpoint for atropine is dried pulmonary secretions and adequate oxygenation.Morgan lenses can be used for eye irrigation. Irrigate the eyes of patients who have had ocular exposure using isotonic sodium chloride solution or lactated Ringer’s solution.The mechanism of action may involve acetylcholine antagonism or ventricular membrane stabilization. The use of intravenous magnesium sulfate has been reported as beneficial for organophosphate toxicity.
Torsades de Pointes should be treated in the standard manner. Continuous cardiac monitoring and pulse oximetry should be established an ECG should be performed.Succinylcholine should be avoided because it is degraded by AChE and may result in prolonged paralysis. Immediate aggressive use of atropine may eliminate the need for intubation. Intubation may be necessary in cases of respiratory distress due to laryngospasm, bronchospasm, bronchorrhea, or seizures. Airway control and adequate oxygenation.Gently cleanse with soap and water to hydrolyze organophosphate solutions. Termination of the exposure including removing all soiled clothing.
Severe reactions can lead to ventilatory failure and death (cholinergic crisis). Skeletal muscle initially exhibits fasciculation (involuntary irregular, violent muscle contractions) followed by the inability to repolarize cell membranes resulting in weakness and paralysis. (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. Since acetylcholinesterase is the enzyme that degrades acetylcholine following stimulation of a nerve, by inhibiting acetylcholinesterase, organophosphates allows acetylcholine to accumulateand result in initial excessive stimulation followed by depression. Acetylcholine is the neurohumoral mediator at the cholinergic junctions.Occurs at cholinergic junctions of the nervous system including postganglionic parasympathetic junctions (sites of muscarinic activity), autonomic ganglia and the neuromuscular junctions (sites of nicotinic activity) and certain synapses in the CNS.
#Atropine antidote for skin#
They can be rapidly absorbed through skin and mucous membranes or by inhalation. Organophosphate compounds are used as commercial insecticides (isulfoton, phorate, dimethoate, ciodrin, dichlorvos, dioxathion, ruelene, carbophenothion, supona, TEPP, EPN, HETP, parathion, malathion, ronnel, coumaphos, diazinon, trichlorfon, paraoxon, potasan, dimefox, mipafox, schradan, sevin, and dimetonor) in chemical warfare (nerve gases such as tabun and sarin) and are applied as aerosols or dusts.
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