Management of the crisis:
(1) discontinuation of the exposure to the causative agent
(2) mechanical ventilation if needed, with control of respiratory secretions
(3) atropine to counter the muscarinic effects
(4) an oxime drug (pralidoxime, obidoxime, other) to counter the nicotinic effect
(5) avoidance of medications that may worsen the symptoms (caffeine, theophylline, loop diuretics)
(6) benzodiazepine therapy to control seizures and/or agitation
Signs of atropine effect (atroponization):
(1) mydriasis (change from miosis)
(2) skin that is warm, dry and flushed
