not-yet-known not-yet-known not-yet-known unknown 2.1 Case History and Examination A 23-year-old male presented to the emergency department (ED) of Dangisharan basic hospital with complaints of vomiting and epigastric pain after half an hour of alleged unintentional dermal exposure of insecticide CPS. On presentation, he was lethargic and salivating. His Glasgow Coma Scale (GCS) score was 13/15 (E3V4M6), pupils were mildly constricted but were bilaterally reactive to light. There was coarse crepitations in the right mid zone on auscultation. Plantar response was bilaterally downgoing. Deep tendon reflexes were 2+. Extremities were cold and clammy. Examination of other systems was normal but a strong smell of insecticide was coming from him. His vitals were as follows: blood pressure (BP) of 104 by 66 mmHg, pulse rate (PR) of 48 per min and regular, respiratory rate (RR) of 10 per min, temperature (Temp.) of 97°F and oxygen saturation (SaO2) of 93% at room air. According to attendants, the patient is a shepherd and was using CPS with bare hands to apply over cow shed. He did not have any significant past psychiatric history. We decided to treat him in line for OP poisoning.