A. Muscarinic overstimulation:
Mnemonic: DUMBBBELS
- Diarrhea/Diaphoresis
- Urination
- Miosis
- Bronchorrhea
- Bronchospasm
- Bradycardia
- Emesis
- Lacrimation
- Salivation
B. Nicotininc overstimulation (NMJ and Sympathetic ganglia):
Mnemonic: Monday, Tuesday, Wednesday, Thursday, Friday (MTWThF)
- Mydriasis/Muscle cramps
- Tachycardia
- Weakness
- Twitching
- Hypertension/Hyperglycemia
- Fasciculations
C. Nicotinic overstimulation in CNS:
Mnemonic: Five Cs
- Confusion
- Consternation (anxiety)
- Convulsions
- Coma
- CVS and respiratory center depression
Common causes of death:
Mnemonic: Killer Bs
- Bradycardia
- Bronchorrhea
- Bronchospasm
Atropine therapy
Mnemonic: 2,3,4,5
2 mg [0.05 mg/kg (children)] IV stat and doubled every 3, 4 or 5 (3-5) minutes until pulmonary muscarinic signs and symptoms are alleviated.
Dosing should be titrated to the therapeutic end point of the clearing of respiratory secretions and the cessation of bronchoconstriction and never by tachycardia and mydriasis.
Atropine infusion:
20% of atropinization dose hourly
Reduce dose by 20% 4 hourly once patient is stable (use 3 point checklist – pulse, blood pressure and chest crackles)
Do not use Succinylcholine for airway management