| Antidote and Emergency Treatment | Treatment is symptomatic and supportive. Oils should not be used as either cathartics or dermal cleansing agents, as they increase absorption. Gastric lavage and use of activated charcoal and sodium sulfate are indicated for ingestion. If dermal exposure occurred, contaminated clothes should be removed, and the skin should be thoroughly cleansed with soap and water. Management of seizures in both children and adults is with Valium or phenobarbital. Respiratory depression and even respiratory arrest, especially with concomitant use of Valium and phenobarbital in children, may occur. These drugs preferably should be used only in critical care areas where emergency endotracheal intubation can be performed. /It is recommended/ that epinephrine not be utilized in patients with organochlorine poisoning, as the organochlorines induce myocardial irritability and ventricular arrhythmias may occur. However, dopamine may be necessary in the event of hypotension unresponsive to fluid administration, and epinephrine may be necessary in the event of cardiopulmonary arrest. /Organochlorine insecticides/Persons exposed to organochlorine pesticides by any route should be observed for sensory disturbances, incoordination, speech slurring, mental aberrations, and involuntary motor activity that would warn of imminent convulsions. If convulsions occur, place the victim in the left lateral decubitus position with the head down. Move away furniture or other solid objects that may be a source of injury. If jaw movements are violent, place padded tongue blades between the teeth to protect the tongue. Whenever possible, remove dentures and other removable dental work. Aspirate oral and pharyngeal secretions, and, when possible, insert an oropharyngeal airway to maintain an open passage unobstructed by the tongue. Minimize noise and any manipulation of the patient that may trigger seizure activity. Administer oxygen by mask. Maintain pulmonary gas exchange by mechanically assisted ventilation whenever respiration is depressed. /Solid organochlorine insecticides/In patients who have been poisoned by organochlorine contamination of skin, clothing, hair and/or eyes, decontamination must proceed concurrently with whatever resuscitative and anticonvulsive measures are necessary to preserve life. Contamination of the eyes should be removed by flushing with copious amounts of clean water. If the pesticide-exposed person remains alert and physically able, a prompt shower and shampoo may be appropriate, provided the patient is carefully observed to insure against sudden appearance of poisoning. If there are any indications of weakness, ataxia, or other neurologic impairment, clothing should be removed and a complete bath and shampoo given while the victim is recumbent, using copious amounts of soap and water. Attendants should wear rubber gloves. Surgical green soap is excellent for this purpose, but ordinary soap is about as good. The possibility of pesticide sequestered under fingernails or in skin folds should not be overlooked. Contaminated clothing should be promptly bagged and not returned until it has been thoroughly laundered. Contaminated leather shoes should be discarded. The possibility that pesticide has contaminated the inside surfaces of gloves, boots, and headgear should be considered. /Solid organochlorine insecticides/If organochlorine has been ingested in a quantity sufficient to cause poisoning, the stomach and intestine must be emptied, and measures taken to limit toxicant absorption. Because seizure activity may develop rapidly, lavage, with a large bore orogastric tube and with rigorous protection of the airway, is probably preferable... . If the victim is convulsing, it is almost always necessary first to control seizures before attempting gastric intubation. The effectiveness of lavage in removing pesticide from the stomach diminishes rapidly with the passage of time. Particularly in poisoning by large doses of organochlorine, monitor pulmonary ventilation carefully to forestall respiratory failure. Assist pulmonary ventilation mechanically with oxygen whenever respiration is depressed. /Solid organochlorine insecticides/For more Antidote and Emergency Treatment (Complete) data for BULAN (6 total), please visit the HSDB record page. |
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