SKENARIO 1

STEP 3 NO 5A,5B,6,7
5. a. What are going to do when person get acute
pesticide poisoining ?
b. What is the possible treatment and antidotum
for the scenario
6. What types of PPE ?
7. The importance using of PPE ?
5a. What are going to do when person acute get pesticide poisoining ?

• Antidotum organofosfat Atropin 2-4 mg iv diulang

selama 1 jam sampai asetilkolinesterasenya tinggi
• Jika pasien sadar: pestisida dikeluarkan
• Jika pasien tidak sadar: tidak boleh dimuntahkan
dan cek pernafasan
• Jika terkena mata : irigasi dengan air mengalir, jika
tertelan maka minum air dalam jumlah yg banyak
5b. What is the possible treatment and

antidotum for the scenario

 FIRST AID
Skin contact:
 Remove contaminated clothes
carefully.
 Wash the skin with running water
for at least 15 minutes.
 Do not use any local application
without seeking medical advice.
FIRST AID Contd…
 Wash eyes with running water for
at least 15 minutes.
 Do not use any eye drops without
seeking medical advice.
 If there is visual impairment seek
medical advice from an
Ophthalmologist.
 FIRST AID Contd…
• Inhalation:
Remove the patient away from the source
and encourage deep breathing of fresh air.
• Ingestion:
Do not induce emesis because some
pesticides have corrosive effects and some
may contain hydrocarbons as solvents.
If patient is semiconscious or unconscious
keep the patient in Neck extended position.
Management of Organophosphate
and Carbamate poiosning Cont…
• Atropine:
The following features of cholinergic
syndrome is an indication for atropine
therapy.
• Poor air entry in to the lungs due to
bronchorrhoea and bronchospasm.
• Excessive sweating
• Bradycardia
• Hypotension
• Miosis
 Management of Organophosphate and

Carbamate poisoning Contd…

• Initial dose: 1.8 – 3 mg, 3-5 of 0.6 mg vials

rapidly IV into a fast flowing IV drip
depending on the condition.
• After 5 min. check the five parameters
and if there is no improvement double
the dose.
Management of Organophosphate
and Carbamate poisoning Contd…

• Once atropinised clinical features:

o Clear lungs
o Adequate heart rate ( > than 80
beats/m.)
o Blood pressure (> 80 mmHg systolic)
o Dry skin
o Pupils no longer pinpoint
o Set up an infusion with 10-20% of total
amount of atropine.
Management of Organophosphate and

Carbamate poisoning Contd…

• Target end points for atropine

therapy.
• Clear chest on ausculatation with
no wheeze.
• Heart rate between 80-100
beats/min.
• Pupils no longer pinpoint.
• Systolic blood pressure > 80 mmHg.
• Dry axillae.
 Management of Organophosphate and

Carbamate poisoning Contd…

• Excess atropine causes confusion,

urinary retention, hyperthermia,
bowel ileus and tachycardia.
• In this condition atropine should be
ceased and the patient reviewed
after 30 min. to see whether the
features of toxicity have settled.
• When atropine toxicity settles 70-
80% of the previous rate.
Management of Organophosphate
and Carbamate poisoning
• Pralidoxime:
Give 30 mg/kg loading dose of
pralidoxime over 10-20 min. followed by a
continuous infusion of 8-10 mg/kg per
hour until clinical recovery (for example
12-24 hours after atropine is no longer
required or the patient is extubated) or 7
days which is later. Less severely
poisoned patients can be given
intermittent doses (1 gram 6 hourly by
slow IV bolus over 10 – 20 mins).
• Oximes are not required for carbamate
poisoning.
 Management of
Organochlorine poisoning
• For convulsions give diazepam 5-10 mg IV
slowly (Paediatric dose 0.2 mg/kg).
Repeat if necessary. Up to 40 mg/day
can be given orally as maintenance
dose.
• Continue diazepam for 3-4 days after
convulsions have been controlled. 10 ml
of 10% calcium gluconate IV can also be
used to control convulsions.
 Management of Paraquat
poisoning
• An absorbent (Fuller’s earth or Activated
charcoal) should be given orally or via a
nasogastric tube as early as possible.
• The dose of Fuller’s earth is 1 litre of 15%
aqueous suspension (Paediatric dose 15
ml/kg body weight).
• If Fuller’s earth is not available give
activated charcoal 50-100g dissolved in
200 ml of water (Paediatric dose 15 ml/kg
body weight).
 Management of Propanil
poisoning
• If symptoms of methaemoglobinaemia are
present (tachycardia, tachopnoea or
confusion) or if the levels are over 30%, give
1% methylene blue 0.1 ml/kg IV over 5
minutes. The same dose may be repeated
within 1 hour if there is no improvement.
• If IV preparation is not available give
methylene bluee 300 mg daily orally. If
methylene blue is not available give ascorbic
acid 1 g IV twice daily.
 Management of
Rodenticide poisoning
• If there has been no bleeding, but the PT is
prolonged, give vitamin K1 10-50 mg orally two to
four times a day (paediatric dose 0.4
mg/kg/dose).
• For prolonged PT with less severe bleeding, give
vitamin K1 10 to 15 mg SC or IM (for a child 1 to 5
mg).
• In severe haemorrhage with prolonged
prothrombin time (PT) give vitamin K1
(phytomenadione) 20 mg by slow IV injection (0.6
mg/kg for children under 12 years).
• In severe bleeding, it may be necessary to give
fresh frozen plasma or fresh blood.
Types of Personal Protective Equipment and Importance of using

PPE(PPE)

PPE controls:
• Requires worker to wear something
• Examples

Source of Photos: OSHA

 Importance of use PPE
• Masker bahan plastik agar pestisida tidak
menempel
• Topi untuk melindungi kepala
• Jubah pelindung/ pakaian panjang untuk
melindungi tubuh
• Sepatu khusus sebagai alas kaki
• Sarung tangan yg melebihi pergelangan tangan
• Kacamata khusus untuk melindungi mata
• Pelindung telinga untuk melindungi telinga
 Types of PPE
Head protection:
• Frequent causes of head injuries
o Falling objects from above striking on the
head;
o Bump head against fixed objects, such as
exposed pipes or beams; or
o Accidental head contact with electrical
hazards.

Source: OSHA
Why head protection is important…

Source: OSHA
• Classes of hard hats:
o CLASS G (General)
• Protect against impact, penetration
• Low-voltage electrical protection (proof-tested
to 2,200 volts)

Source of graphics:
OSHA
o CLASS E (Electrical)
• Designed for electrical/utility work
• Protect against falling objects, impact
• Electrical protection against high-voltage
(proof-tested to 20,000 volts)

Source: OSHA
Eye and face protection:

Source of images: OSHA

• Common causes of eye injuries
o Chemical splashes
o Blood or OPIM splashes or sprays
o Intense light
o Dust and other flying particles
o Molten metal splashes

Source: OSHA
• Selecting eye and face protection –
elements to consider:
o Ability to protect against workplace
hazards
o Should fit properly
o Should provide unrestricted vision and
movement
o Durable and cleanable
o Allow unrestricted functioning of other PPE
• Safety glasses
o Used to protect against moderate
impacts from particles

Source of graphics: OSHA

• Prescription glasses
o Employees who use
prescription glasses while
performing operations with
potential eye hazards must use Source: OSHA

eye protection that:

• Incorporates the prescription in its design, or
• Can be used over your prescription glasses
without interfering with the proper positioning of
the prescription glasses or goggles
• Goggles
o Protect eyes, and the
facial area immediately
surrounding the eyes from
impact, dust, splashes. Source: OSHA

o Some can be used over

corrective lenses, if they fit
them.
 o Goggle types

Direct-ventilated Indirect-ventilated Non-ventilated

• Resist direct passage • Prevents fogging • Does not allow the
of large particles into by allowing air passage of air into the
the goggle circulation goggle
• Prevents fogging by • Protects against • Prevents splash entry
allowing air circulation liquid or chemical
• May fog and require
splash entry
frequent lens cleaning
Source: OSHA.gov
• Face shields
o Protect face from nuisance
dusts and potential splashes
or sprays of hazardous liquids
o Shields do not protect from
impact hazards unless so rated Source: OSHA

o Shields are for face protection, not eye

protection. To protect the eyes, wear
safety glasses with side shields, or
goggles under the face shield.
• Laser safety goggles
o Provide protection from hazards:
• physical contact such as flying particles
• ultraviolet light, laser, and welding

Source: OSHA
Respiratory protection:

Source of photos: OSHA

• Types of respirators
o Air-Purifying (APR) –
remove contaminants
from air
• Particulate respirators
• Chemical cartridge/
gas mask respirator
• Powered Air-Purifying
Respirator (PAPR)

Source of photos:
OSHA
• Inspecting and cleaning respirators
o Inspect all respirators for wear and tear before
and after each use
o Wash in a detergent solution; then, disinfect by
immersing in a sanitizing solution

Source of photos: Carmen Vazquez

• Storing respirators
o Protect against dust, sunlight, heat, extreme
cold, excessive moisture, and damaging
chemicals
o Store in position to retain natural configuration

Source of photos: Carmen Vazquez

Hearing protection:

Source of photos:
OSHA
• Exposure to noise levels
over 85 dB can cause
hearing loss
• Hearing protection
required at 90 dB
• Implement effective
Hearing Conservation
Program

Source: OSHA
• The employer must Permissible Noise Exposure
provide ear protection 29 CFR 1910.95(b)(1)

when the noise level in Duration per Sound Level

Day (hours) (dBA)
the work area is greater
than indicated in this 8 90

table. 6 92
4 95
3 97
2 100
1 105
1/2 110
1/4 115
Source: NIOSH
Impact noise should not exceed 140 dB
 Types
of PPE
• How to insert
ear plugs
properly

Source: NIOSH
 Types of PPE
Hand protection:
• Potential hazards for hands
o Skin absorption of hazardous
substances
o Lacerations or severe cuts
o Punctures
o Chemical burns
o Thermal burns
o Extreme temperatures

Source of photos: OSHA

 Types of PPE
• Types of gloves

Anti-vibration
Chemical-resistant Leather Palm

Heat-resistant Cut-resistant
Permeation-resistant
Source of photos: OSHA
 Types of PPE
Foot and leg protection:
• Causes of foot injuries:
o Falling or rolling of heavy objects
o Crushing or penetrating materials
o Sharp objects that can penetrate
the sole
o Exposure to molten metal
o Working on, or around, hot, wet, or
slippery surfaces
Source: OSHA

o Working when electrical

hazards are present.
 Types of PPE
• Conditions
requiring foot
protection
o Impacts
o Compressions
o Cuts/punctures
o Chemicals Source: OSHA

o Temperatures
• Examples of foot and leg protection
o Impact-resistant toe and/or instep
• Steel
• Composite
o Heat-resistant soles
o Metal shanks
o Specialty footwear may be needed
• Metatarsal guards
• Liquid- or chemical-resistant
• Conductive or nonconductive
Source of photos: OSHA
• Protection from hazards
o Shoes with metal toe-cap
protects against knocks, falling
objects
o Rubber shoes protect against
chemical materials, as
directed
by the SDS

Source of photos: OSHA

Body protection –
protective clothing:

Source of photos: OSHA

• Provide protective clothing
for those parts of the body
exposed to possible injuries
• Types of body protection
o Laboratory coats
o Coveralls
o Vests
o Jackets
o Aprons
o Surgical gowns Source of photos: OSHA

o Full-body suits
• Selection of body
protection – variety of
materials effective against
particular hazard
o Paper-like fiber – dust and
splashes
o Treated wool and cotton –
fire-resistant; dust, abrasions,
rough/irritating surfaces
o Duck – cuts, bruises
o Leather – dry heat, flames
o Rubber, rubberized fabrics,
neoprene, and plastics –
certain chemicals and Source of photos: OSHA

physical hazards