A 41-year-old farm worker is brought to the emergency department after collapsing in a field following acute organophosphate pesticide exposure. He presents with diaphoresis, wheezing, miosis, muscle fasciculations, and diarrhea. Vital signs show BP 98/62, HR 48, RR 28, SpO2 88% on room air. Serum cholinesterase is markedly decreased at 15% of normal. He denies chest pain. Which of the following is the most appropriate initial pharmacologic treatment?
- A)Naloxone plus atropine
- B)Physostigmine only
- C)Atropine plus pralidoximeGABARITO
- D)Flumazenil plus pralidoxime
- E)Methylene blue
Explicação
Organophosphates irreversibly inhibit acetylcholinesterase, causing muscarinic, nicotinic, and central cholinergic excess. Atropine treats muscarinic symptoms, and pralidoxime can regenerate acetylcholinesterase if given before aging occurs. Ver explicação completa e trilha adaptativa →