Abstract
Tamilnadu, an agriculture-based state in India, suffered severe drought during 2014 to 2016 when the number of suicides increased among farmers. Organophosphorus compound (OPC) poisoning is a common method of committing suicide among farmers since it is easily available as pesticides. Mortality rate in OPC poisoning in India is 15%. To propose an algorithm for timely interventions in managing OPC poisoning patients that may help the physician in decisionmaking and decreasing mortality. Retrospective chart review of OPC poisoning patients between August 7, 2014 and August 6, 2016. All OPC poisoning patients above 18 years of age who were previously healthy are included. Patients who were pregnant, refusing to consent, exposed to other toxins, hospitalized elsewhere prior to ED arrival, or underwent cardiac arrest were excluded. Mortality is the main outcome measured. 108 patients were included in the study out of which 9 patients were clinically stable and did not require any intervention. 86 patients needed inotrope/vasopressor support, 91 patients had dyselectrolytemia. 59 patients required administration of sodium bicarbonate. 87 patients were intubated in the ED. 12 patients were intubated in the ICU. Minimum duration endotracheal tube required was 5 days and maximum intubated days was 8. On the ninth day, intubated patients were either extubated (26 patients) or tracheomised (73 patients). Reintubation rate was nil. 12 patients had intermittent syndrome. 28 patients had seizure, 9 patients developed signs of myocardial suppression and 4 developed ARDS. Minimum duration of hospital stay is 5 days and maximum was 38 days. Minimum duration of ICU stay was 3 days and maximum was 31 days. All 108 patients were safely discharged home and mortality was nil. This study shows resuscitation and stabilization, timely interventions like early administration of antidote, shock management, intubation and appropriate ventilator settings and proper ICU and nursing care altogether may nullify mortality resulting from organophosphorus compounds poisoning.Tabled 1INTERVENTIONINDICATIONSurface decontamination, Gastric lavage and activated charcoalAll organophosphorus compound poisoning patientsAtropineDUMBBELLSNeed for mechanical ventilationIntubation and mechanical ventilationBronchorrheaSpo2 < 94% with oxygen face maskRespiratory muscles weaknessShock refractory to fluidsGCS < 9SeizureIntermediate syndromeElectrolyte correctionDyselectrolytemia including Ca++, Mg++, K+Inotropes / vasopressorsShock refractory to fluidsCentral venous accessMultiple infusions, prolonged stayArterial accessInvasive BP monitoring, blood gasesSodium bicarbonateMetabolic acidosis with pH < 7.10AntiepilepticsSeizureTracheostomyProlonged mechanical ventilationGlucose – insulin – potassiumSigns of myocardial injury likePersistent bradycardia (refractory to atropine and dopamine)Hypotension refractory to inotropes and vasopressorsST segment changesDecrease in ejection fractionGlobal hypokinesiaGlycemic control140 - 180 mg/dl maintainedTemperature controlNormothermia maintained Open table in a new tab
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