Agency for Toxic Substances and Disease Registry
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The goal of Case Studies in Environmental Medicine (CSEM) is to increase the primary care provider’s knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients. This CSEM focuses on cholinesterase inhibitors, including pesticides and chemical warfare nerve agents. | |
Two versions of the Cholinesterase Inhibitors, Including Insecticides and Chemical Warfare Nerve Agents CSEM are available.
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To make the most effective use of this course, we recommend that you:
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This course is designed to help you learn efficiently. Topics are clearly labeled so that you can skip sections or quickly scan sections you are already familiar with. This labeling will also allow you to use this training material as a handy reference. To help you identify and absorb important content quickly, each section is structured as follows: |
Section Element | Purpose |
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Title |
Serves as a "focus question" that you should be able to answer after completing the section |
Learning Objectives |
Describes specific content addressed in each section and focuses your attention on important points |
Text |
Provides the information you need to answer the focus question(s) and achieve the learning objectives |
Key Points |
Highlights important issues and helps you review |
Progress Check exercises |
Enables you to test yourself to determine whether you have mastered the learning objectives |
Progress Check answers |
Provides feedback to ensure you understand the content and can locate information in the text |
Upon completion of the Cholinesterase Inhibitors, Including Insecticides and Chemical Warfare Nerve Agents CSEM, you should be able to |
Topic | Objectives |
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Community preparedness |
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What are cholinesterase inhibitors? |
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What types of pathology do cholinesterase inhibitors cause? |
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What is the cholinergic toxidrome? |
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Clinical findings are due to a mixture of nicotinic and muscarinic effects |
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Effects on routine laboratory tests |
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Differential diagnosis |
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Signs and symptoms: Differences in pediatric cases |
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Who is at risk for exposure? The exposure history |
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RBC and serum cholinesterase levels |
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Direct measurement of cholinesterase inhibitors and their metabolic byproducts |
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Management Strategy 1: Prevention of secondary exposure |
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Management strategy 2: Supportive care |
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Management strategy 3: Medications - Atropine |
Identify
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Management strategy 3: Medications - 2-PAM |
Describe
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Management strategy 3: Medications - Diazepam |
Describe
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Syrup of ipecac, gastric lavage, cathartics, and activated charcoal |
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Public health and medico legal issues |
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The intermediate syndrome |
Describe the
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Organophosphate-induced delayed neuropathy (OPIDN) |
Identify the
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Organophosphorus ester-induced chronic neurotoxicity (OPICN) |
Describe
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Other issues related to cholinesterase inhibitor toxicity |
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