Decontaminate immediately - takes priority, prevent exposure of health care workers, remove patient from exposure and remove all clothing
Atropine (antimuscarinic)
2-4mg IV q5min, titrate to resolution of bronchorrhea (may need > 100 mg total dose)
Then initiate atropine infusion at 10% of total initial dose and titrate up by 0.2 mg/kg/hr to maintain resolution of bronchorrhea
Benzodiazepines prn for seizures
Lorazepam 2-4 mg IV
Pralidoxime (2-PAM)
Loading dose 20 mg/kg (max 2 g) IV bolus x 30 minutes then
Infusion 8-10 mg/kg/hr (max 650 mg/hr) IV
Consider intubation and mechanical ventilation
Poisoning of acetylcholinesterase will prolong effects of succinylcholine.  Consider nondepolarizing agent such as rocuronium if paralytic needed
2-4mg IV q5min, titrate to resolution of bronchorrhea (may need > 100 mg total dose)
Then initiate atropine infusion at 10% of total initial dose and titrate up by 0.2 mg/kg/hr to maintain resolution of bronchorrhea
Lorazepam 2-4 mg IV
Loading dose 20 mg/kg (max 2 g) IV bolus x 30 minutes then
Infusion 8-10 mg/kg/hr (max 650 mg/hr) IV
Poisoning of acetylcholinesterase will prolong effects of succinylcholine.  Consider nondepolarizing agent such as rocuronium if paralytic needed
Cholinergic crisis
Carbamate toxicity
Heat stroke
Mushroom toxicity, especially:
Neurogenic shock
Amanita muscaria
Serotonin syndrome
Inocybe