ffRemove contaminated clothing (use gloves) ffWash contaminated skin with lots of water ffEstablish and maintain the airway ffAtropine 2-4 mg IM or IV (according to the severity of the poisoning) Child: 0.05 mg/kg per dose –– Double dose every 3-5 minutes until signs of atropinisation occur (stopping of bronchial secretions and broncoconstrictions) –– Continuous infusion of atropine 0.05 mg/kg/ hour may be necessary –– Reduce dose of atropine slowly over 24 hours but monitor for patient’s status ffAssisted respiration with air or oxygen may be required during the first 24 hours after poisoning ffGive IV fluids, e.g., normal saline prn for dehydration, hypovolaemia, and shock ffPrevent and treat convulsions with diazepam 10 mg IV Child: 0.2 mg/kg IV or 0.5 mg/kg rectal ffSalbutamol 5 mg (2.5 mg for children <5 years) nebulisation if bronchospasm: ffPerform gastric lavage if the poison was ingested (up to 6 hours after ingestion) but consider risk of aspiration ffGive standard dose of activated charcoal if patient presents within 2 (up to 4) hours ffMonitor patient for a few days (worsening can occur a few days after ingestion)}<b>In moderate to severe poisoning (only if not responding to adequate doses of atropine)</b><br>ffAdd pralidoxime mesylate 30 mg/kg IV over 30 minutes Child: 25-50 mg/kg IV –– Continue with infusion 8 mg/kg/hour Child: 10-20 mg/kg/hour