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Opfinalppt 160117042516 PDF
Opfinalppt 160117042516 PDF
15%
SUICIDAL
ACCIDENTAL
85%
5%
9%
HOUSE WIVES
10%
42% FARMERS
SHOPKEEPERS
LABOURERS
34% STUDENTS
21%
35%
SPRING
WINTER
12% RAINY
SUMMER
32%
16%
36%
Me Parathion
19%
Diazinon
Chlorpyriphos
Dimecron
29%
2. Intermediate Syndrome
1. Excessive Sweating
2. Miosis
3. Bronchorrhoea / spasm
4. Bradycardia
5. Hypotension
3. Bronchorrhoea
• Early cause of morbidity and mortality
• Neck flexors
- a constant feature
- one of the earliest signs
- inability of patients to raise heads off pillow
• Muscarinic symptoms :
absent
rarely short relapses may occur
IMS- complications
• Weakness -- Frank paralysis
Sensory
1. Glove-stocking anesthesia
2. Cerebellar signs +/-
6. COPIND
• Chronic OP induced Neuro-psychiatric disorder
• No cholinergic symptoms
• Unknown mechanism.
* Lin CL, Yang CT, Pan KY, Huang CC. Most common intoxication in nephrology
ward organophosphate poisoning. Ren Fail 2004 ;26:349-54. .
9. Acute Pancreatitis
• d/t Excessive cholinergic stimulation and
ductular hypertension
- Socrates
1. Identification of poison
• History by patient/ attendant
• Clinical presentation.
• By showing photographs.
• WHO colour code on container.
Poison :Identification
Red label Extremely toxic Monocrotophos, zinc phosphide, ethyl mercury acetate,
and others.
Green label Slightly toxic Mancozeb, oxyfluorfen, mosquito repellant oils and
liquids, and most other household insecticides.
Identification of poison
• Signs of cholinergic excess or developing
and non-Organophosphorus.
Management :Immediate, Protocol
Assess and record 15-point Glasgow Coma Scale.
0.9% normal saline, Aim SBP > 80 mm Hg & urine output >30 ml/h
When not sure about the poison..??
atropine.
*1 Erdman AR. Insecticides. In: Dart RC, Caravati EM, McGuigan MA, et al, eds. Medical toxicology, 3rd edn. Philadelphia:
Lippincott Williams & Wilkins, 2004: 1475–96.
*2 Aaron CK. Organophosphates and carbamates. In: Shannon MS,Borron SW, Burns M, eds. Clinical management of
poisoning and drug overdose, 4th edn. New York, Elsevier Science, 2006.
Initial Stabilisation
Gastrointestinal decontamination
• Often first intervention
• To be considered only
after stabilization,
oxygen, atropine and
oximes.
• Lavage only if patient
arrives within 1 hour.
• Only consider if patient
Not beneficial, rather increases chances of
intubated or conscious Aspiration Pneumonia & Deaths*
and willing to
cooperate. * The Hazards of Gastric Lavage for Intentional Self Poisoning
in a Resource Poor Location Clin Tox 2007;45(2):136-43
Gastrointestinal decontamination
• Induced emesis : Ipecacuanha induced ,
Contraindicated.
• Activated charcoal : Studies failed to
find any benefit ( Why..??)
It binds in vitro, but not in gut due to
NO evidence suggests that
rapid absorption. patients
with pesticide poisoning
Ingested benefit
dose too large for thewith
amount of *charcoal.
activated charcoal.
* Eddleston M, Juszczak E, Buckley NA, et al. Randomised controlled trial of routine single or
multiple dose superactivated charcoal for self-poisoning in a region with high mortality. Clin
Toxicol 2005; 43: 442–43.
Muscarinic antagonist
Atropine
Muscarinic Antagonist
Good CNS penetration, cause Anticholinergic delirium, agitation and
psychoses.
Glycopyrrolate
Less CNS penetration, Less CNS side effects.
Lesser respiratory complications
Ineffective in countering Coma and reduced respiration.
A 1. Clear Chest
1. Lung secretions
T 2. SBP > 80mmHg
2. Hypotension R
3. HR > 80/min
3. Bradycardia O
4. Sweating P 4. Dry Axillae
6. Bowels : Hyperactive
N 6. Bowel sounds : Just present
E
Atropine Dosing
Incremental Dosing V/S Bolus Dosing
• Extubate if :
spontaneous breathing with no distress.
generates VT >5 mL/kg at Pressure of 3-5 cm of H2O.
Role of Alkalinization
• IV infusion of Soda. Bicarbonate produce moderate
alkalinization (pH : 7.45 to 7.55) in OP poisoning.
from circulation.