• To be able to do a risk assessment of acute organophosphate exposure.
• Consider variables which may affect the risk assessment.
• Understand treatment of organophosphate poisoning.
• Understand the issues underlying treatment failure.
• Understand the chronic sequelae organophosphate poisoning.

Note: In a tutorial you should receive additional questions that relate to your answers.

A 56-year-old man presents 2 hours after drinking an unknown amount of chlorpyrifos concentrate. Prior to this he had been drinking alcohol.

You are in a hospital that has had its pathology service restricted. .’There are no fancy tests here, doctor.’ was the prerecorded message you receive when you ring the lab.

On arrival, his Glasgow Coma Score is 9. He smells of cheap liquor, pesticide and the vomit that covers his chest.

His pulse is 130, BP 130/80. There is scattered wheeze throughout his chest. His mouth contains some vomit, which has not made it to his chest. He is moving his limbs and his reflexes are present but depressed. You do not see any muscle fasciculations.

1. Discuss the risks to this patient. What would help you define the risk?
2. Discuss your initial treatment. What would you do? How much would you do?

A 56-year-old man presents 2 hours after drinking an unknown amount of fenthion concentrate. Prior to this he had been drinking alcohol.

You are in a hospital that has the leading (recently privatised) pathology service in your area. The pathology car park is congested with late model Mercedes.

On arrival his Glasgow Coma Score is 9. He smells of cheap liquor, pesticide and the vomit that covers his chest.

His pulse is 130, BP 130/80. There is scattered wheeze throughout his chest. His mouth contains some vomit, which has not made it to his chest. He is moving his limbs and his reflexes are present but depressed. You do not see any fasciculations.

1. Discuss the risks to this patient. What would help you define the risk?
2. Discuss your initial treatment. What would you do? How much would you do?