1. How to treat organophosphate poisoning (Nerve agent/insecticide)
Duodote: Be prepared
How to treat organophosphate poisoning (Nerve agent/insecticide)

2. Indications DuoDote is for the treatment of organophosphate poisonings
No contraindications in the presence of organophosphate poisoning
Shall be administered by EMSP
Self administration
Patient administration
Intended for initial sign & symptom management…not to replace definitive medical treatment

3. safety Prevention is “Best Practice” When managing ensure you use PPE:
Appropriate mask
Gloves
Sleeves
Etc.

4. safety Increased Susceptibility to Atropine: Elderly Children
Pregnant female

5. Organophosphorus nerve agents
Tabun
Sarin
Soman VX

6. Routes of exposure Eyes Nose Airways Combination of all 3
May be a delay between time of exposure and S/S

7. Organophosphorus insecticides
40 registered in the US (2009)
Exposure:
Hand to mouth
Inhalation
Absorption
Nausea, vomiting, muscle contractions, difficulty breathing/CP, salivation, weakness, paralysis, seizures, and possible death

8. Exposure risk
Mixing
Loading
Transporting
Spill

9. Recognize poisoning Blurred vision (miosis) Teary eyes Runny nose
Salivation (drooling)
Chest tightness or difficulty breathing
Nausea and vomiting
Wheezing, coughing, or increased airway secretions
Stomach cramps
Tachycardia or bradycardia

10. Recognize severe poisoning
Strange or confused behavior
Severe difficulty breathing or copious secretions from lungs/airway
Involuntary urination and defecation
Convulsions
Unconsciousness

11. Effect on the body OP binds with acetylcholinesterase
Preventing breakdown of acetylcholine
Acetylcholine buildup
Change in heart rate
Excess salivation
Sweating
Tearing
Runny nose
Breathing difficulties
Loss of bladder and bowel control

12. How duodote works (atropine & pralidoxime chloride
Reactivates acetylcholinesterase
Relieves symptoms caused by excessive activity of nicotinic receptors
Minor role in relieving increased activity of muscarinic receptors

13. How duodote works (atropine & pralidoxime chloride
Relieves airway constriction
Reduces secretions
Reverses the contractions of smooth muscles
Decreases bronchoconstriction
Reduces hyperactivity in gastrointestinal musculature

14. Atropine Blocks some of the muscarinic cholinergic receptors
Smooth muscle
Cardiac muscle
Secretory glands
Neurons
Central nervous system
Peripheral nervous system

15. Together (Pralidoxime & Atropine)
Restore cholinergic nerve function

16. Duodote auto-injector
BinaJect technology
2 separate liquid-filled chambers
2 drugs delivered sequentially through single needle
Designed to be administered by EMSP

17. Initial dosing 2 or More Mild Symptoms 1 Duodote to med-outer thigh
Wait 10 – 15 minutes for change
If no additional S/S or no severe signs no additional injections needed
Transport patient for definitive medical attention

18. Worsening symptoms
If S/S worsen or the patient exhibits additional S/S:
Administer 2 additional Duodotes in rapid succession
Seek medical attention

19. Severe s/s upon initial presentation
Administer 3 Duodotes
Immediately medical attention

20. Administering Open container Place in dominant hand
Green (needle) down
Remove grey safety cap
Keep fingers from either end

21. Administering Injection site is mid-outer thigh
Administer through trousers
Ensure nothing is in pocket
Administer at 90 degree angle
Hold for 10 seconds
Once removed inspect for presence of needle

22. Administering If no needle is present attempt to administer again
Once removed bend the needle on hard surface
Package all used Duodotes and send with patient

23. Special populations Safety in children has not been established
Pregnancy – Risk versus Benefit
Elderly and Children more susceptible to Atropine effect

24. storage 77 degrees Excursions up to 86 degrees Keep from freezing
Protect from light

25. Questions