This is the E.M. Kases, EM Quick Hits podcast, where our team of experts and educators bring

you clear, concise, and condensed, practice-changing knowledge on all those EM topics that you may not be totally comfortable with. Cases, the latest evidence, procedural

tips and tricks, pitfalls to avoid, and the key take-home points and references on the EM cases

website. Quick, let's get on with it. First up, we got Talks Guru, Emily Austin, on

organophosphate poisoning.

You're working a late night shift in the emergency department when you get a call overhead to recess. You look in and you see a young guy who's drowsy with vomit all over his shirt. He's dripping

with sweat and appears to be

breathing really quickly. Their paramedic that brought him in mentions to you that this guy told

him he swallowed a pesticide that he brought back from his native country of Bangladesh about two

hours ago. Your alarm bells start to go off. This guy is not looking good. His vital signs support

your instinct. He's got a heart rate

of about 40 and his blood pressure is around 90 over 60. Monitor is giving you a reading of an

oxygen saturation of about 84%. Just before you go examine him, something tells you, I should

probably get all gowned up. So you don a mask, a face shield, a gown and some gloves.

As the nurse is applying oxygen, you listen to his lungs. There's crackles and wheezes all over.

Just before leaving the room, you look in his pupils, their pinpoint.

If you're asking yourself, could this really be a case of an organophosphorus pesticide poisoning

here in my ED in North America?

Well, you would be right. These cases just aren't something that we see every day, but across the

globe there's over 200,000 cases of acute pesticide poisoning seen every year, and occasionally these

patients do present to us. Organophosphorus compounds are pesticides that work by inhibiting that acetyl colon estuaries enzyme.

Other compounds like carbamate pesticides or nerve agents like sarin, for example, inhibit this

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