Clinical scenario

 A 30 year old house wife from a nearby village is brought in the afternoon in
an unconscious state.there is h/o domestic violence . Patients clothes are
wet and are soliled with urine and feces.

 O/E : pupils are constricted with BP=80/60 mmHg.you check patients blood
sugar level which is 480mg/dl.you order an ABG which is metabolic
acidosis.ECG is done and it shows bradycardia.

DIAGNOSIS ???
ORGANO PHOSPHATE
POISONING
(EMERGENCY MANAGEMENT)

PREPARED BY:
SREEJA.M
M.sc (N) I st year,
College of nursing,
JIPMER
OBJECTIVES:

 Define OPC poisoning

 List down the clinical features of OPC poisoning.
 Explain the emergency management of OPC
poisoning
DEFINITION

 Poisoning occurs after dermal ,respiratory, oral

exposure to either organophosphate pesticides
(eg., chlorpyrifos, dimethoate,malathion,parathion)
or nerve agents (eg.,tabun,sarin) causing inhibition
of acetylcholinesterase at nerve synapses.
CLINICAL FEATURES
Features due to overstimulation of muscarinic acetylcholine receptors in the
parasympathetic system
 Bronchospasm
 Bronchorrhoea
 Miosis
 Lachrymation
 Urination
 Diarrhoea
 Hypotension
 Bradycardia
 Vomiting
 Salivation
Features due to overstimulation of nicotinic acetylcholine
receptors in the sympathetic system

 Tachycardia

 Mydriasis

 Hypertension

 Sweating
Features due to overstimulation of nicotinic and
muscarinic acetylcholine receptors in the CNS

 Confusion

 Agitation

 Coma
 Respiratory failure
Features due to overstimulation of nicotinic acetylcholine
receptors at the neuromuscular junction

 Muscle weakness

 Paralysis

 Fasciculations
Emergency management
of OPC poisoning
DECONTAMINATION
IMMEDIATE MANAGEMENT

 Check airway, breathing, and circulation

 left lateral position

 Oxygen support

 Intubate the patient if their airway or breathing is

compromised
 ATROPINE
 Initial bolus of 1.2-3.0 milligrams IV in an adult depending on severity of
symptoms.

 Double the dose of IV atropine every 5 min to achieve adequate atropinization.

clear chest on auscultation

HR>80 beats/mint

SBP > 80 mmHg.

 Follow with continuous infusion of 10% - 20% per hour of the initial dose of
atropine that was required to achieve adequate atropinization.
 OXIME INFUSION

 Give as soon as possible , may be given 24-48 h after

exposure 30 mg/kg IV in adults.
 Continue to review respiratory function. Intubate and
ventilate patients if tidal volume is below 5 mL/kg or vital
capacity is below 15 mL/kg, or if they have apnoeic spells,
or PaO2 is less than 8 kPa (60 mm Hg) on FIO2 of more
than 60%

 Treat agitation by reviewing the dose of atropine being

given and provide adequate sedation with
benzodiazepines.
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