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Organophosphates irreversibly inhibit acetylcholinesterase, allowing acetylcholine to accumulate at muscarinic, nicotinic, and CNS synapses. Muscarinic signs include secretions, bronchospasm, miosis, bradycardia, and gastrointestinal or urinary effects; DUMBBELS is a mnemonic for several of these findings. Nicotinic effects can include fasciculations, weakness, and paralysis, while CNS involvement may range from anxiety to seizures, coma, or respiratory depression. Emergency management emphasizes responder protection and prompt decontamination, followed by airway and respiratory support. Atropine and pralidoxime are described as antidotal therapies, with seizure treatment and continuous monitoring also addressed. Laboratory testing can support diagnosis and severity assessment, but treatment should not be delayed while awaiting results.