Medical First Aid Guide


Table 17: ORGANOPHOSPHATE AND CARBAMATE INSECTICIDES

Organophosphorus and carbamate insecticides cause disturbances in the transmission of nerve impulses to target organs such as muscles and glands by inhibiting the enzyme acetylcholinesterase.

Signs and symptoms may include:

  • Headache, nausea, dizziness, fatigue
  • Blurred vision, pin-point pupils
  • Confusion
  • Vomiting, abdominal cramps and diarrhoea
  • Sweating, salivation, watering of the eyes, and increased nasal and lung secretions
  • Muscle twitching, weakness, tremor, convulsions
  • Tightness in the chest, wheezing, slow pulse, respiratory and cardiac arrest.

Symptoms usually develop during exposure or within 12 hours after contact. The acute intoxication stage usually does not last longer than 48 hours unless exposure has been prolonged or the insecticide has been ingested. Recovery from exposure to carbamate insecticides usually occur within 24 hours.

  • IMMEDIATE washing of the eye with copious amounts of water.

Further advice on eye treatment: see table 7.

  • IMMEDIATE washing with soap or shampoo and copious amounts of water for at least 10 minutes while removing contaminated clothing, rings, wristwatches, etc.
  • The casualty should shower thoroughly.
  • Chemical protective gloves should be worn by those attending the exposed individual to prevent self-contamination.
    Further advice in cases of skin burns: see table 8.
  • Contaminated clothing should be kept in properly labelled bags until washing.
  • Remove the casualty to the ship’s hospital.
  • RADIO FOR MEDICAL ADVICE if symptoms develop.

(Toxic effects may be expected particularly after inhalation of dust and mist)

  • Remove the casualty from the polluted atmosphere, have him rinse his mouth and give one glass of water to drink.
  • Remove clothes and shower thoroughly.
  • RADIO FOR MEDICAL ADVICE if symptoms develop.
  • Have the casualty rinse his mouth thoroughly with water.
  • RADIO FOR MEDICAL ADVICE.
Signs and symptoms
irrespective of routes of exposure
Treatment
Blurred vision, headache, nausea, fatigue or dizziness
  • Observe in a place of safety.
  • RADIO FOR MEDICAL ADVICE.
  • If the casualty becomes free of symptoms, no further action is required.
Vomiting, cramp-like abdominal pains, excessive sweating and salivation, tightness in the chest or twitching of the muscles
  • RADIO FOR MEDICAL ADVICE.
  • Inject 1 mg atropine intramuscularly. If the skin and mouth have not become dry within 30 minutes, give a further dose of 1 mg atropine intramuscularly. In casualties severely poisoned with an organophosphorus insecticide, very large doses (10 to 15 mg) of atropine may be required.
  • CAUTION: Overdosage of atropine may lead to fever, restlessness, hallucinations and disorientation, followed by depression, respiratory arrest and death. If atropine toxicity is suspected, discontinue further treatment with atropine.
Respiratory difficulty with excessive lung secretions, paralysis with complete loss of muscle function, slow pulse, or unconsciousness
  • Administer controlled ventilation with oxygen at a flow rate of 8 L per minute and heart compression as warranted.
  • If a medically trained individual is available, atropine should be given intravenously as follows: 1 to 2 mg repeated every 15 minutes until lung secretions have dried up.
Further advice: see table 2 and table 3.
  • Transfer to shore hospital is URGENT.
  • A patient who has had significant exposure or any symptoms related to exposure should be kept warm in bed and closely observed for 48 hours and RADIO MEDICAL ADVICE OBTAINED.
  • Since atropine has a short action, vomiting, cramp-like pains, excessive sweating and salivation or tightness of the chest may reappear after initial improvement with atropine therapy.
  • If these symptoms recur, repeat injection of atropine as described above. In very severe poisoning this may be necessary for 24 to 48 hours.
  • Some organophosphorus insecticides may damage the nerves in the limbs after the casualty’s recovery from acute poisoning. The muscles controlled by those nerves may become weak, and paralysis with complete loss of muscle function may occur.
  • RADIO FOR MEDICAL ADVICE AND TRANSFER THE CASUALTY TO A SHORE HOSPITAL AS SOON AS POSSIBLE.

Table 16: Hydroflouric acid and hydrogen flouride

Table 18: Cyanides