I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
- inhibit cholinesterases leading to accumulation of acetylcholine at NM junctions
- Acute Cholinergic Toxicity (though bradycardia in organophosphates in particular is apparently rare)
- 2mg (0.05mg/kg for a child) every 5 mins doubled each time (Toxbase)
- goals are dry lungs, HR> 80, BP >80
- pralidoxime (reactivates cholinesterase)
- Toxbase says give it everyone who gets atropine
- 2g (30mg/kg in a child) IV followed by an infusion
- A combo pen with atropine and pralidoxime in it together is available
- benzos for agitation and seziures
Of note this was covered before on this site in 2012 looking at mainly the pesticide version