NBME Step 2 CK Form 7 Atropine (NBME Answers)

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submitted by ∗nc1992(25)

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This is not correct. While atropine is the correct answer to manage organophosphate poisoning, it is more appropriate to stop the seizure immediately. Benzos should be given initially in the presence of seizure with atropine and 2-pam for management of poisoning

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etherbunny The atropine would work as fast as the benzo. We also don't know the duration of the seizure- benzos are only indicated after initial measures to control the seizure have failed. https://www.aafp.org/afp/2003/0801/p469.html +

lindasmith462 Yea this is a crappy question - you could DEF make an argument for diazepam as it indicated specifically for seizures in organophosphate poisoning and does act faster than the atropine. Early benzo use (regardless of seizures) has been associated with improved long term neuro probs and really should be given WITH/"right after" atropine. I guess I went with this question is getting at me knowing this is organophosphate poisoning and what to do vs seizure. https://www.uptodate.com/contents/image?topicKey=EM%2F339&search=organophosphate%20poisoning%20treatment&imageKey=EM%2F63540&rank=1~28&source=see_link +

jmorga75 You could make an argument for a benzo, but that benzo def wouldn't be diazepam that has a half life of 1-3 days. If you were going to give a benzo you'd have to give a short-medium acting one (midazolam, Alprazolam, or lorazepam). Also, atropine, unlike benzoes, slows down the aging process of organophosphates, so it's probably better to give atropine ASAP. +

lindasmith462 diazepam is the specific benzodiazepine indicated in the treatment of organophosphate poisoning associated seizures and was noted to work faster than atropine in animal models. in this case you would give both at the same time. thus the crappyness of this question +

machetebetty I wonder if actually their point (...in that darling NBME way...) is to differentiate between "next best step" (which could be either, and realistically, in the ED it's all just happening ASAP) vs "most appropriate pharmacotherapy"- i.e., what's the antidote for the core problem (as opposed to, benzos as symptomatic/supportive care in this case). [Kinda like that Q w/ the pregnant person who also has an SBO >> pregnancy was a diagnosis but not THE diagnosis... darned NBME punks XD ] +