Organophosphate / carbamate poisoning

Sources: agricultural insecticides (chlorpyrifos, malathion, parathion), nerve agents (sarin, VX, novichoks), some medical anticholinesterases. Carbamates (carbaryl, propoxur) cause similar toxidrome but spontaneously reactivate cholinesterase. Personal protective equipment: gloves, gown, eye protection — secondary contamination is a real risk for staff. Decontamination FIRST: • Remove all clothing (double-bag for disposal). • Copious soap + water washing of skin and hair. • Eye irrigation with 0.9% saline if contact. • Activated charcoal 50 g PO/NG within 1 h of ingestion if airway secure. ABCDE; high-flow oxygen; large-bore IV access; continuous monitoring; bloods inc. plasma butyrylcholinesterase (more sensitive) and red-cell acetylcholinesterase if available.