Insecticide poisoning is an increasing event which requires a thorough knowledge base for diagnosis and management. Awareness of the importance of decontamination is fundamental not only in the prehospital care phase but also in the emergency department. A thorough knowledge of the essentials of emergency and critical care is indispensable for the management and support of ventilatory and circulatory functions. Specific antidotal therapy utilizing atropine and pralidoxime is usually necessary in the immediate care of acute cases. In addition, use of pralidoxime after acute exposure may contribute to a beneficial outcome. Appropriate laboratory determinations in the acute phase are necessary parameters for successful outcomes. The use of cholinesterase determinations for diagnostic and prognostic purposes is discussed.