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Lookup NU author(s): Dr Elspeth Hulse
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© 2019. Organophosphorus (OP) nerve agent poisoning made the headlines in 2018 with the nerve agent ‘Novichok’ poisonings in Salisbury, England. This event highlighted a gap in the knowledge of most clinicians in the UK. In response, this special article aims to enlighten and signpost anaesthetists and intensivists towards the general management of OP nerve agent poisoned patients. Drawing on a broad range of sources, we will discuss what OP nerve agents are, how they work, and how to recognise and treat OP nerve agent poisoning. OP nerve agents primarily act by inhibiting the enzyme acetylcholinesterase, causing an acute cholinergic crisis; death usually occurs through respiratory failure. The antimuscarinic agent atropine, oximes (to reactivate acetylcholinesterase), neuroprotective drugs, and critical care remain the mainstays of treatment. The risk to medical staff from OP poisoned patients appears low, especially if there is a thorough decontamination of the poisoned patient and staff wear appropriate personal protective equipment. The events in Salisbury in the past year were shocking, and the staff at Salisbury District General Hospital performed admirably in treating those affected by Novichok nerve agent poisoning. We eagerly anticipate their future clinical publications so that the medical community might learn from their valuable experiences.
Author(s): Hulse EJ, Haslam JD, Emmett SR, Woolley T
Publication type: Review
Publication status: Published
Journal: British Journal of Anaesthesia
Year: 2019
Volume: 123
Issue: 4
Pages: 457-463
Print publication date: 01/10/2019
Online publication date: 24/06/2019
Acceptance date: 05/04/2019
ISSN (print): 0007-0912
ISSN (electronic): 1471-6771
Publisher: Elsevier Ltd
URL: https://doi.org/10.1016/j.bja.2019.04.061
DOI: 10.1016/j.bja.2019.04.061
