77 一位50歲男性，被家人發現意識不清後送到急診（1小時前還清醒），此時病患血壓105/60 mmHg，心跳70/min，呼吸36/min，體溫37.5℃，昏迷指數GCS（Glasgow coma scale）=E1V2M4，兩眼瞳孔直徑1 mm等大，皆有光反應，淚水多，痰液分泌多。下列處置何者錯誤？

可給予100%氧氣及插管可注射atropine

可注射PAM（pralidoxime） 注射atropine之最大劑量不可超過3 mg

ANS D

THIS IS A CASE OF POISONING!!!

MOST LIKELY ORGANOPHOPHATE

The effects of organophosphate poisoning are recalled using the mnemonic SLUDGEM (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal motility,Emesis, miosis

These side effects occur because of the excess acetylcholine that results from blocking acetylcholinesterase. In addition, bronchospasm, blurred vision and bradycardia may result.

An additional mnemonic is DUMBELLS: Diarrhea, Urination, Miosis, Bradycardia, Bronchoconstriction, Emesis, Lacrimation, Salivation, Sweating, Secretion

Initial single doses in adults vary from around 0.5 mg to 1 mg (5-10 mL of the 0.1 mg/mL solution for antisialagogue and other antivagal effects, to 2 to 3 mg (20-30 mL) of the 0.1 mg/mL solution) as an antidote for organophosporous or muscarinic mushroom poisoning. When used as an antidote, the 2 to 3 mg dose should be repeated no less often than every 20 to 30 minutes until the signs of poisoning are sufficiently lessened or signs of atropine poisoning (see ADVERSE REACTIONS and OVERDOSAGE) occur.