Intoxications with pesticides and cholinesterase inhibitors

1. Big picture

This is a classic toxicology emergency. The examiner wants you to recognize:

Pesticide exposure + wet patient + miosis + bronchorrhea + bradycardia + muscle fasciculations/weakness = cholinesterase inhibitor poisoning.

The dangerous cause of death is usually respiratory failure, from three mechanisms acting together:

Bronchorrhea + bronchospasm
        +
Respiratory muscle weakness
        +
Central respiratory depression/seizures
        ↓
Hypoxia → cardiac arrest

Immediate management is not “wait for cholinesterase level.” It is:

**Protect staff → decontaminate → ABC → oxygen/suction/intubate if needed → atropine until lungs dry → pralidoxime