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Organophospha Te (Op) Poisining: Presented by
Organophospha Te (Op) Poisining: Presented by
TE (OP) POISINING
PRESENTED BY
SOPHY TC
SECOND YEAR MSC NURSING
GEVT.COLLEGE OF
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NURSING
KOTTAYAM
DEFINITION
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PATHOPHYSIOLOGY
Acetylcholine (ACh) is one of the main
neurotransmitters of the vertebrate nervous system. It
is released at certain (cholinergic) nerve endings and
may be excitatory or inhibitory; it initiates muscular
contraction at neuromuscular junctions. Acetylcholine
receptors (cholinoceptors) fall into two main classes:
muscarinic and nicotinic receptors. Once
acetylcholine has been released it has only a transitory
effect because it is rapidly broken down by the
enzyme cholinesterase.
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cholinesterase (acetylcholinesterase) An enzyme
that hydrolyses the neurotransmitter acetylcholine to
choline and acetate. Cholinesterase is secreted by
nerve cells at synapses and by muscle cells at
neuromuscular junctions. Organophosphorus
insecticides (pesticide) act as anticholinesterases by
inhibiting the action of cholinesterase.
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PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
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SIGNS AND SYMPTOMS OF
ORGANOPHOSPHATE POISONING
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SIGNS AND SYMPTOMS
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SIGNS AND SYMPTOMS
(i) Type-I paralysis or Acute paralysis
Develops within 24-48 hours
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SIGNS AND SYMPTOMS
(ii) Type-II paralysis or Intermediate
syndrome
Develops after the acute cholinergic crisis, 24-96hrs
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SIGNS AND SYMPTOMS
(iii) Type-III paralysis or OP-Induced
delayed polyneuropathy
OP-induced delayed polyneuropathy (OPIDP) is a
sensory-motor distal axonopathy
After the ingestion of large doses of certain OP
insecticides or after chronic exposure.
After 2-3 weeks of acute poisoning episode
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DIAGNOSIS
Other laboratory findings include the following:
Leukocytosis
Hemoconcentration
Hyperglycemia
Hypokalemia
Hypomagnesemia
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ORGANOPHOSPHATE (OP) POISINING
MANAGEMENT
Initial treatment goal
Optimizing oxygenation
Controlling excessive airway secretions..
Magnesium Sulphate
Sodium bicarbonate
Clonidine
pralidoxime
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GASTROINTESTINAL
DECONTAMINATION
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ATROPINE
1. An initial loading dose of 1.8–3.6 mg rapidly IV into a
fast-flowing IV drip.
2. Three to five minutes after giving atropine, check the
markers of atropinisation .A uniform improvement in most
of the cholinergic features is required clear chest on
auscultation, increase in heart rate and blood pressure.
3. If, after 3–5 minutes, a consistent improvement across
the five parameters has not occurred, then double the dose,
and continue to double each time till the patient is
completely atropinised.
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ATROPINE
Maintenance dose of atropine:
After achieving complete atropinisation, an atropine infusion
should be started.
The usual dose requirement is 10 – 20% of the dose of
atropine required to load the patient every hour.
In most cases, the patient will not require more than 3-
5mg/hour of atropine.
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BENZODIAZEPINES
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MAGNESIUM SULPHATE
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SODIUM BICARBONATE
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CLONIDINE
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PRALIDOXIME
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FRESH FROZEN PLASMA
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TREATMENT
MEDICAL CARE
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TREATMENT/
MEDICAL CARE
Continuous cardiac monitoring and pulse oximetry should be
established; an ECG should be performed.
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TREATMENT
MEDICAL CARE
Complications include
respiratory failure
Seizures
aspiration pneumonia
delayed neuropathy
death.
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COUNSELLING
Counselling to the poisoned patients will reduce
:
the chances of a repeat attempt at poisoning.
It also enables the health care personnel to
improve the quality of treatment, minimize the
cost of therapy and the period of hospitalization.
Family counselling is mandated; this helps the
family members to cope with the situation and
accept the patient as he is.
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NURSING MANAGEMENT
Ineffective airway clearance related to presence of copious
secretions secondary to OP compound effects.
Endotracheal tube was secured
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NURSING MANAGEMENT
Decreased cardiac output related to cholinergic
effects of OP poisoning.
Close monitoring of hemodynamic status (blood
pressure, MAP and heart rate) . MAP was
maintained between 70-80 mmHg. Atropine was
administered to maintain the target heart rate
[ Day 1: 110/min; Day 2: 100/min; Day 3: 90/min].
Adequate intravenous fluids were administered
to prevent dehydration due to salivation &
diarrhea.
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NURSING MANAGEMENT
Risk of fluid volume deficit related to effects of OP
poisoning.
Intravenous fluids
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NURSING MANAGEMENT
Ineffective coping of family: related to guilt,
negative feelings and financial crises.
Open communication encourage among the family
members
Family counselling
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NURSING MANAGEMENT
Risk of complications such as pressure sores, and
ventilator associated pneumonia (VAP) related to
poisoning effects and prolonged mechanical ventilation.
Positioning