What are typical signs of organophosphate poisoning and basic EMS management?

• A. SLUDGE symptoms (salivation, lacrimation, urination, defecation, GI upset, emesis), miosis, bradycardia; decontaminate skin, monitor, administer antidotes per protocol, transport promptly
• B. High fever and dehydration; administer antibiotics
• C. Headache only; treat with aspirin
• D. Skin rash; apply topical cream

Answer: (A)

Organophosphate poisoning triggers a cholinergic crisis from acetylcholinesterase inhibition, so the most telling signs are muscarinic effects plus related manifestations. You’ll see excessive secretions and tearing, uncontrolled urination and defecation, gastrointestinal upset with emesis, and pinpoint pupils (miosis). The heart often slows, so bradycardia is common. This cluster of symptoms—SLUDGE (salivation, lacrimation, urination, defecation, GI upset, emesis) with miosis and bradycardia—best matches the typical presentation EMS teams look for in organophosphate exposure.

In terms of management, the priority is to prevent further exposure and address the cholinergic excess. Decontaminate the patient’s skin to reduce ongoing absorption, then monitor airway, breathing, and circulation. Administer antidotes per protocol (usually atropine to counter muscarinic effects and pralidoxime to reactivate acetylcholinesterase) and provide supportive care while preparing for rapid transport to an appropriate facility for definitive treatment.

The other options don’t fit this scenario: high fever with dehydration and antibiotics doesn’t reflect a cholinergic crisis; headache alone isn’t characteristic and isn’t managed with aspirin in this context; a skin rash treated with topical cream isn’t related to organophosphate poisoning.