why was atropine removed from acls?

[Kiwiology]

A function of environment perhaps?

Perhaps, I'm not sure but there are lots of places around the world where OP based agricultural products are used and/or stored in sufficient quantities to cause poisoning if ingested. New Zealand is a farming nation (no bloody lame ass jokes please...)

However, the atropine used for OP wasn't autoinjectors.

That he was not however I thought I'd cover it as well

[chbare]

Never dealt with ingestion, cutaneous exposure however.

[croaker260]

While my county has transitioned from agricultural /urban to surburban sprawl/urban in the span of about 12 years....we are still a largely ag and wilderness state. Therefore, we do have real risks of organophosphates in our area. To say that we are "drinking the koolaid" is a bit uneducated...to say the least.

We carry duodote on all of our rigs, enough for three administrations for three crew members, plus our mass casualty stocks. Before that we carried similar amounts of the Mark I kits and CANA kits.

We also carry the "high dose" Atropine in the kits, 8 mg in 20 cc, for ETT atropine (when we still did that), and organophosphate poisonings)

Never dealt with ingestion, cutaneous exposure however.

Cutaneous exposure is most common. We have a large migrant farm worker population in our AG industry, and mistakes are often made when the various OP is mixed for spraying. Our neighboring county had 8 in a single incident last year.

Ingestion is rare, usually intentional, and VERY hazardous to all responders. The patient will continue to "off gass" the OP during resuscitation, sespire external/GI Decon. I seem to recall a case a number of years ago where the body exposed numerous responders, including the ER staff, tot he point of significant symptoms and closing an ER.

[systemet]

Ingestion is rare, usually intentional, and VERY hazardous to all responders. The patient will continue to "off gass" the OP during resuscitation, sespire external/GI Decon. I seem to recall a case a number of years ago where the body exposed numerous responders, including the ER staff, tot he point of significant symptoms and closing an ER.

I just want to make sure I understand what you're saying --- if someone intentionally takes organophosphates orally, enough can be excreted across the lungs / dermis to cause a hazard to the responders?

[croaker260]

Well, it is dose dependent, but if they consume (relatively) high enough quantities.... yes. Add the vomitus the patient will likely produce as well.

But this is exceedingly rare, only heard of a few cases over the (20 plus) years.

Look up detergent suicide. Far more common (still rare) but very lethal to all involved if you are not prepared.

[craig]

So, what do you use for organophophate poisoning if not atropine?

yeah we use it for op poisoning as well