Organophosphate poisoningRefer

• Atropine, Pralidoxime, Diazepam (seizures / agitation), Activated charcoal (within 1 h)

• Also: Remove clothes and wash the skin; target clear chest, HR above 80, SBP above 80, dry axillae, pupils no longer pinpoint; intubate early; no suxamethonium (Lancet 2008)

First visit

• Clinical diagnosis — Smell, pinpoint pupils, secretions, sweating, bradycardia — treat with atropine at once.
• ECG — Bradycardia, QT prolongation.
• SpO₂ / blood gas — Respiratory failure.

Only if indicated

• Serum (plasma) cholinesterase — Confirms exposure where available; does not guide atropine.
• Creatinine, electrolytes, amylase, CK — Baseline and complications.
• Chest X-ray — Aspiration.

Follow-up and monitoring

• Chest auscultation, HR, BP, pupils, axillary sweat every 5–15 min — Atropine titration until atropinised.
• Neck flexion strength and single-breath count — Days 1–4 (intermediate syndrome).