You are caring for a 40-year-old man who was exposed to an unknown chemical and has been appropriately decontaminated by the hazardous materials team. The patient responds to pain only, is incontinent of urine and feces, and has a heart rate of 40 beats/min and weak. Further assessment reveals that his breathing effort is poor and his blood pressure is low. After taking standard precautions, the MOST appropriate treatment for this patient involves:

Question

A) protecting his airway with an ET tube, monitoring his cardiac rhythm, establishing vascular access, initiating an epinephrine infusion at 2 µg/min, and considering 0.5 mg of atropine.
B) assisting his ventilations with a bag-mask device and 100% oxygen, performing intubation if necessary, establishing vascular access, applying the cardiac monitor, and administering atropine and pralidoxime.
C) applying high-flow oxygen via nonrebreathing mask, establishing vascular access, applying the cardiac monitor, attempting immediate transcutaneous cardiac pacing, and administering several 20-mL/kg boluses of normal saline.
D) immediately administering 2-PAM chloride, applying supplemental oxygen via nonrebreathing mask, establishing vascular access, administering crystalloid fluid boluses to increase his blood pressure, and monitoring his cardiac rhythm.

Answer 1

Answer: B) assisting his ventilations with a bag-mask device and 100% oxygen, performing intubation if necessary, establishing vascular access, applying the cardiac monitor, and administering atropine and pralidoxime.