Organophosphate intoxication as a consequence of mouth-to-mouth breathing from an affected case

2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

In this focused update, the American Heart Association provides updated guidance for resuscitation of patients with cardiac arrest, respiratory arrest, and refractory shock due to poisoning. Based on structured evidence reviews, guidelines are provided for the treatment of critical poisoning from benzodiazepines, β-adrenergic receptor antagonists (also known as β-blockers), L-type calcium channel antagonists (commonly called calcium channel blockers), cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetics, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel antagonists (also called sodium channel blockers), and sympathomimetics. Recommendations are also provided for the use of venoarterial extracorporeal membrane oxygenation. These guidelines discuss the role of atropine, benzodiazepines, calcium, digoxin-specific immune antibody fragments, electrical pacing, flumazenil, glucagon, hemodialysis, hydroxocobalamin, hyperbaric oxygen, insulin, intravenous lipid emulsion, lidocaine, methylene blue, naloxone, pralidoxime, sodium bicarbonate, sodium nitrite, sodium thiosulfate, vasodilators, and vasopressors for the management of specific critical poisonings.

Respiratory protection for Health Care Workers

Chemical, Biological, Radiological and Nuclear incidents are rare, but the likelihood of any medical facility having to deal with contaminated or contagious casualties is not, Health Care Workers (HCW) often being exposed to infectious or toxic substances. Although medical staff routinely take measures to protect themselves against exposure to infection by wearing protective clothing, they rarely consider the inhalational route as a threat. This paper presents a series of cases where HCW's have been exposed to toxic or infectious material through the respiratory route, discusses standards of respiratory protection and describes how this risk can be mitigated to protect medical personnel.

Epidemiology of acute organophosphate poisoning in hospital emergency room patients

Acute organophosphate (OP) poisoning is a major health issue in developing countries. Organophosphate insecticides inhibit cholinesterase (ChE) enzymatic activity, thereby eliciting cholinergic signs and symptoms. Victims of OP poisoning require immediate hospital emergency room (ER) treatment to prevent a fatal outcome. We present an epidemiologic review of acute OP poisoning in hospital ER patients. Areas of interest include countries with acute OP poisoning, nature of exposure, gender and age of patients, clinical cholinergic features, ChE activity, and health outcome, including recovery rate, case fatality rate, and post-ER complications. The review comprises case reports, hospital surveys, and clinical studies on acute OP poisoning. More studies were conducted in developed than in developing countries. Suicidal and occupational OP poisoning in agricultural workers was prevalent in developing countries, whereas accidental OP poisoning was prevalent in developed countries. Healthcare workers in the ER were also affected by OP poisoning. Both males and females were affected. Children accounted for 35% of the OP-poisoned victims. Patients presented with a classic cholinergic syndrome and serum ChE depresssion, with a recovery rate above 90%. Neurologic impairment was the most frequent complication. Preventing environmental OP exposure and increasing the awareness of pesticide toxicity would reduce acute OP poisoning and protect human health.

Nerve agents: a comprehensive review

Nerve agents are perhaps the most feared of potential agents of chemical attack. The authors review the history, physical characteristics, pharmacology, clinical effects, and treatment of these agents.