Introduction: Organophosphorus compounds (OPCs), widely used in agriculture and households, are a major cause of poisoning-related deaths, especially in developing countries like India. The severity of poisoning depends on the compound type, dose and treatment timing, making early intervention essential for better outcomes. Materials and Methods: This prospective study at MGM Medical College (Sept 2022–June 2024) included 70 OPC poisoning patients, categorized into ventilatory and non-ventilatory groups. Data on demographics, clinical symptoms, GCS scores and lab parameters were collected. Standard treatment protocols were followed and SPSS version 26 was used for statistical analysis. Results: OP poisoning predominantly affected younger individuals, with 64.28% of cases under 40 years and females (55.71%) were more affected than males (44.28%). Housewives (31.42%) were the most affected occupational group and suicidal intent was the primary cause (81.42%). Malathion (25.71%) was the most commonly consumed OP compound. Nausea and vomiting were the most common symptoms (74.28%), while respiratory failure occurred in 51.42% of cases. Moderate to severe impairment was prevalent, with 54.28% of patients having a GCS score of 8-11 and 35.71% scoring below 8. The majority had serum cholinesterase levels of 2001-5000 IU/L (55.71%), while 35.71% had significant inhibition (1001-2000 IU/L). Mechanical ventilation was significantly associated with delayed hospitalization (p=0.012), respiratory failure (p=0.032), fasciculations (p=0.001), low GCS scores (p=0.001) and reduced serum cholinesterase levels (p=0.028), while age, sex and pinpoint pupils showed no significant correlation. Outcomes varied, with 68.57% being discharged, 24.28% dying and 7.14% leaving against medical advice, reflecting the severity and variability in recovery patterns among OP poisoning cases. Conclusion:  Our study highlights the critical role of mechanical ventilation, GCS scores, serum cholinesterase and amylase levels in determining OP poisoning outcomes. Patients with severe respiratory failure and low GCS scores had higher mortality, emphasizing the need for early intervention and intensive medical care to improve survival rates.