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Somebody needs to figure out how we can get CEUs for

reading all of your email.

Now that's a project I'd support! Ha!

Melody Malouf

**************************

>Gene,

>

>You are correct, to a point.

>

>Treatment of organophosphate (OP) poisoning consists of the

>administration

>of atropine, a drug that blocks the effects of the excess

>acetylcholine

>(ACh) at muscarinic ACh receptor sites; and of 2-pyrdine

>aldoxime methyl

>chloride (2-PAM Cl, also called pralidoxime chloride), an

>oxime that will

>remove the OP from acetylcholinestrase (AChE), thereby

>reactivating the

>enzyme after poisoning by OP. However, it is ineffective

>against OP once

>they have " aged " . Ventilatory support is necessary when

>breathing has

>stopped or is inadequate, and the anticonvulsante diazepam

>(Valium) may need

>to be administered (these patients convulse with large

>exposures).

>

>Aging is a process by which one of the OP's alkyl groups

>leaves the

>molecule. After de-alkylation, an AChE-bound nerve agent

>molecule can no

>longer be removed from the enzyme by an oxime. The aging

>process varies from

>OP to OP (I have no figures, sorry).

>

>2-PAM Cl is an oxime that increases the rate of breakdown of

>the OP-AChE

>complex to regenerate the AChE (in effect, the 2-PAM Cl

> " pries " the OP from

>the AChE, think 2-PAM crowbar). 2-PAM Cl ameliorates muscle

>weakness,

>fasciculations, and alterations of consciousness, it does NOT

>relieve

>bronchospasm or bronchorrhea. It is synergistic with

>atropine. Dose:

>600-1800 mg IM or 1g IV SLOWLY; may repeat 600 mg or 1 g dose

>every hour up

>to three times.

>

>The BIGGEST factors to OP treatment are:

>1> avoid exposing yourself (routes are inhalation and

>absorption);

>2> decontaminate the patient THOROUGHLY (skin exposure is

>possible);

>3> airway and respiratory support;

>4> atropine until secretions are dried and airway is open;

>5> 2-PAM Cl if available (give it EARLY on).

>

>Keep safe all,

> Webb

>

>______________________________________________________

>

>------------------------------------------------------

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>

>

>

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