| Topic |
Objectives |
|
Community preparedness |
- Identify key community agencies that should be involved in planning, training, and exercises for hazardous materials emergencies and disasters,
such as those due to exposure to cholinesterase inhibitors
- Describe the consequences that result when many patients exposed to hazardous materials, such as cholinesterase inhibitors, transport themselves
to the hospital.
|
What are cholinesterase inhibitors? |
- Describe how cholinesterase inhibitors, including organophosphorus compounds (e.g., pesticides, nerve agents) and carbamates block the ability of acetylcholinesterase to break down acetylcholine.
|
What types of pathology do cholinesterase inhibitors cause? |
- Identify the 4 major types of pathology caused by cholinesterase inhibitors
|
What is the cholinergic toxidrome? |
- Describe what causes the cholinergic toxidrome.
- Identify generally where cholinergic receptors are found.
- Identify the differences between nicotinic and muscarinic receptors.
- Identify why excessive levels of acetylcholine (the cholinergic toxidrome) cause different signs and symptoms depending on whether cholinergic receptors involved are of the muscarinic or nicotinic type.
|
Clinical findings are due to a mixture of nicotinic and muscarinic effects |
- Describe factors that account for variation in the clinical presentation of cholinesterase toxicity.
- Describe the CNS effects cholinesterase inhibitor toxicity.
- Describe what is known about the nicotinic and muscarinic effects of cholinesterase toxicity on the central nervous system.
- Identify 4 factors contributing to respiratory failure and death in cases of cholinesterase inhibitor toxicity.
|
Effects on routine laboratory tests |
- Describe what routine laboratory tests can be altered by acute cholinesterase inhibitor toxicity.
|
Differential diagnosis |
- Identify other medical conditions that can be mimicked by the cholinergic toxidrome.
|
Signs and symptoms: Differences in pediatric cases |
- Identify how the in clinical presentation in pediatric cases of the cholinergic toxidrome differs from that in adults.
|
Who is at risk for exposure? The exposure history |
- Identify potential sources of exposure to cholinesterase inhibitors.
- Identify the important elements to include in an exposure history when evaluating patients who might be suffering from cholinesterase inhibitor toxicity.
|
RBC and serum cholinesterase levels |
- Describe the usefulness and limitations of laboratory analysis of RBC and serum cholinesterase levels.
|
Direct measurement of cholinesterase inhibitors and their metabolic byproducts |
- Describe the usefulness and limitations of laboratory analysis for the presence of cholinesterase inhibitors themselves and their breakdown products in biological specimens.
|
Management Strategy 1: Prevention of secondary exposure |
- Describe 5 key strategies for preventing secondary exposure from patients contaminated with cholinesterase inhibitors.
|
Management strategy 2: Supportive care |
- Identify the most important organ system requiring supportive care in patients suffering from the cholinergic toxidrome.
|
Management strategy 3: Medications - Atropine |
Identify
- The mechanism by which atropine counters the effects of the cholinergic toxidrome.
- Findings against which to titrate atropine dosage.
- The preferred routes of administration of atropine.
- The type of cholinesterase inhibitor toxicity that may require extremely high doses of atropine.
|
Management strategy 3: Medications - 2-PAM |
Describe
- How 2-PAM works as an antidote.
- How 2-PAM influences the body's response to atropine and vice-versa.
- What “aging” is, as it relates to 2-PAM, and how the process can affect response to treatment.
- Situations that delay the onset of toxicity and aging of cholinesterase inhibitors.
- Reasons for treatment failure with 2-PAM.
- The recommendations for use of 2-PAM in carbamate poisoning.
|
Management strategy 3: Medications - Diazepam |
Describe
- Why seizure prevention and control is important in the management of the cholinergic toxidrome.
- The difference in the risk of seizures between adults and pediatric cases of the cholinergic toxidrome.
|
Syrup of ipecac, gastric lavage, cathartics, and activated charcoal |
- Describe the roles of the following treatment modalities in the management of poisoning due to cholinesterase inhibitors:
- Syrup of ipecac.
- Gastric lavage.
- Cathartics.
- Activated charcoal.
|
Public health and medico legal issues |
- Describe the importance of notifying public health authorities and other emergency response agencies in poisonings due to cholinesterase inhibitor.
|
The intermediate syndrome |
Describe the
- Clinical findings in the intermediate syndrome.
- Significance of the intermediate syndrome in regards to morbidity and mortality due to cholinesterase inhibitor poisoning.
- Treatment and prognosis for intermediate syndrome.
|
Organophosphate-induced delayed neuropathy (OPIDN) |
Identify the
- Clinical findings in OPIDN compared to the intermediate syndrome.
- Available treatments for OPIDN.
- Current knowledge about the cause of OPIDN.
|
Organophosphorus ester-induced chronic neurotoxicity (OPICN) |
Describe
- Our current level of understanding about the association of OPICN and asymptomatic exposures to cholinesterase inhibitors.
- Current treatment options.
|
Other issues related to cholinesterase inhibitor toxicity |
- Describe our current knowledge about the association of cholinesterase inhibitor exposure with
- Cancer risks.
- Fetal effects.
- Gulf War I illness.
- Immune system effects.
|
