Point-of-care lung ultrasound during atropine titration in severe organophosphate poisoning: A case report

Organophosphate (OP) poisoning frequently results in respiratory failure and requires rapid atropine titration to clinical endpoints that are often subjective and difficult to assess in high-acuity emergency settings. We report the use of serial point-of-care lung ultrasound (LUS) as a complementary diagnostic adjunct during atropine escalation in severe OP poisoning. A young patient presented with severe cholinergic toxidrome and hypoxic respiratory distress. Baseline 4-zone anterior LUS demonstrated diffuse confluent B-lines consistent with marked interstitial-alveolar involvement. Atropine was administered using a sequential doubling strategy, and repeat LUS examinations during resuscitation demonstrated a progressive reduction in B-line burden corresponding with cumulative atropine dosing and clinical improvement. The patient recovered without requiring mechanical ventilation. This case illustrates a novel application of lung ultrasound as a complementary diagnostic adjunct during assessment of pulmonary involvement in acute OP poisoning and suggests a potential role for ultrasound in toxicologic resuscitation.