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And for bonus points, what commonly used chemical can induce OPP?

Well now, THERE is something worth dragging an old topic out for! :lol:

It's a shame that an opportunity this good was presented on the board and left incomplete. People would rather argue about basics intubating than discuss realistic patient care scenarios. That's what's wrong with the profession!

How can we possibly let this topic pass without telling EMTs exactly what "organophosphates" are and how to recognize them? The most commonly found organophosphates are insecticides. Commercial names like diazinon, malathion, parathion, Dursban, Spectracide and Real Kill are found in just about every garage and garden shed in America. While they are no longer sold in glass as they still were in the 1980's, you can still find old glass bottles of them in many homes.

And yes, Protopam was used in 1985. I studied it in paramedic school in 1979.

Now, does somebody want to discuss SLUDGE for us, or did everybody learn everything they will ever need to know in EMT school?

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Some years ago, we had a HazMat. A "Pole Pig," better known as a pole mounted electrical transformer, exploded, spilling it's PVC laden cooling oil onto the street below.

The onscene lieutenant from EMS was witnessed by the head of EMS Special Operations Division, doing, or having done the following errors, for which he was fined heavily and immediately:

1) The Lieutenant drove through the contaminated street, spreading the oil.

2) was found smoking a cigarette

3) while standing outside his vehicle

4) with the windows down

5) with an open cup of coffee

6) and an open box of Dunkin Donuts, one half eaten, on the seat

7) while being downwind

8) and downhill from the contamination.

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  • 1 month later...

I hope the medic classes I'm currently enrolled in are the norm and not the exception. Organophosphate poisoning was my first guess. It was covered rather extensively in our Hazmat section. And yes SLUDGE is still the acronym of choice in the classroom.

Rid, before you pick on me responding to old posts...they are a great source of education for those of us still in school. You know, applying what you learn to real life and all that jazz! :lol:

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  • 7 months later...

(Acad Emerg Med Volume 13 @ Number 4 359-364,

published online before print March 10, 2006, doi: 10.1197/j.aem.2005.10.018

© 2006 Society for Academic Emergency Medicine BASIC INVESTIGATION

Multiple Centrally Acting Antidotes Protect against Severe Organophosphate Toxicity

Marco L.A. Sivilotti, MD, MSc, Steven B. Bird, MD, Jean C.Y. Lo, MS and Eric W. Dickson, MD

From the Departments of Emergency Medicine and of Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada; Ontario Regional Poison Information Centre (MLAS), Toronto, Ontario, Canada; Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts (SBB), Worcester, MA; and Department of Emergency Medicine, University of Iowa (JCYL, EWD), Iowa City, IA.

Address for correspondence and reprints: Marco L. A. Sivilotti, MD, Department of Emergency Medicine, Queen's University, 76 Stuart Street, Kingston, Ontario, Canada, K7L 2V7. Fax: 613-548-1374; e-mail: sivilotm@meds.queensu.ca.)

Background: Accumulation of acetylcholine in the central nervous system is believed to account for the rapid lethality of organophosphate pesticides and chemical nerve agents. Diazepam is known to supplement atropine therapy, but its specific mechanism of action is uncertain.

Objectives: To test four centrally acting agents for early antidotal efficacy in severe dichlorvos poisoning in the murine model.

Methods: The up-and-down method was used to dose four candidate antidotes: diazepam, xylazine, morphine, and ketamine. Antidotes were administered subcutaneously to unsedated adult Sprague-Dawley rats who were pretreated with 3 mg/kg intraperitoneal glycopyrrolate. All animals received 20 mg/kg of dichlorvos subcutaneously 5 minutes later. A blinded observer adjudicated the outcomes of 10-minute mortality and survival time.

Results: All animals pretreated with either no antidote (8/8 deaths) or glycopyrrolate alone (8/8) died within 10 minutes of dichlorvos injection. Pretreatment with diazepam (3/9 deaths), or xylazine (3/9), decreased lethality substantially (Fisher p = 0.007; median effective doses, 0.12 mg/kg and 3.0 mg/kg, respectively). Intermediate doses of morphine (3.1 to 5.5 mg/kg) resulted in survival, but higher doses did not, presumably because of excessive respiratory depression (7/11 deaths; p = 0.09). Ketamine (7/8 deaths) was ineffective as an antidote. Survival times also were prolonged in the diazepam and xylazine groups (log-rank p < 0.001) and, to a lesser degree, the morphine group (p = 0.07).

Conclusions: Doses of diazepam, xylazine, and morphine below those used for deep sedation protect against severe dichlorvos poisoning, implying that several distinct central mechanisms are each sufficient to avert lethality. These findings suggest new possibilities for prophylaxis or therapy.

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