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Organophosphates: Insecticide Poisoning and Nerve Agents

Organophosphates: Insecticide Poisoning and Nerve Agents (GA, GB, GD, GF, VX)


Chemical Treatment Guide 4: GREEN


Organophosphate compounds are used as insecticides in residential applications as well as
commercial agriculture. They are found as liquids, dusts, wettable powders, concentrates, and
aerosols. Chemical nerve agents include Tabun (GA), Sarin (GB), Soman (GD), GF, and VX.
Many are well absorbed through intact skin, so they pose a serious hazard to rescuers. Simple
water washing may be sufficient to remove oily compounds. Routes of exposure include skin
absorption, eye contact, inhalation, and ingestion.
Organophosphates affect both the parasympathetic nervous system (muscarinic effects) and the
sympathetic nervous system (nicotinic effects). Although the muscarinic effects may be reversed
with atropine, the nicotinic effects may cause respiratory paralysis and require intubation and
aggressive ventilatory support. Organophosphates may be incorporated in a flammable base.


Exposure may produce the classic SLUDGE syndrome (excessive Salivation, Lacrimation,
Urination, Diarrhea, Gastrointestinal distress, and Emesis). Additional muscarinic effects include
bronchorrhea, bronchospasm, and bradycardia. The patient will have constricted pupils (miosis,
which may last as long as 2 months) with inhalation or skin exposure. Ingestion may or may not
cause miosis. However, stimulation of nicotinic receptors will produce tachycardia, muscle
paralysis (apnea), muscle twitching/fasiculations, and seizures.

• Pesticides (e.g., Chlorthion, Diazinon, Dipterex, Di-Syton, Malathion, Parathion, Phosdrin)
• Chemical warfare agents (e.g., VX, Sarin, Tabun, Soman)

PPE (usually Level A) with SCBA must be worn in the hazardous area when organophosphates
are present. PPE with a minimum of Level C protection must be worn for treatment outside the
hazardous areas.

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