This case comes from Dr Philip Lunsford.
Dr Lunsford is an ER physician and Simulation Director for the Guthrie Robert Packer Hospital emergency medicine residency program in Sayre, Pennsylvania, USA. He completed his training at Carolina’s Medical Center in Charlotte, North Carolina. He has interests in simulation education and has developed the simulation education program for the new emergency medicine residency program.
Why It Matters
This case highlights an uncommon, but clinically and academically important toxidrome. Organophosphate poisoning is a well-known (but rare in developed nations) toxidrome with specific antidotes available for patient treatment and survival. This case allows for its
recognition and treatment to be reviewed.
Clinical Vignette
A 60-year old farmer presents to the ED with a runny nose, vomiting and diarrhea. He feels short of breath and dizzy. He looks so unwell that he is placed into the resuscitation bay. Initial vital sign show tachypnea, hypoxia, and bradycardia. You are immediately concerned about the copious nasal and oral secretions.
Case Summary
This elderly berry farmer, struggling with rising costs, has accidentally poisoned himself using hand-sprayed organophosphate-based pesticide. He arrived in the ED clinically unstable with symptoms of classic cholinergic toxicity. The team leader must identify the toxidrome and direct the team to early PPE use and patient decontamination. Aggressive treatment with antidotes will prevent the need for a high-risk intubation. After appropriate treatment, the patient improves and is admitted to the ICU for monitoring.
EM Sim Cases 