6 .OP poisoning
History of present illness:
The patient was apparently asymptomatic 9 days ago ( i.e on 18/11/21 ) then he consumed the poison , while he was drinking alcohol at night.
He consumed 250 ml
And immediately spitted it out . He was immediately rushed to the nearby hospital in unresponsive condition . CPR was intiated and continued for 15 mins .
Patient was intubated and kept Under mechanical ventilator for 4 days .
He was given gastric lavage there and inotropic supplements . K+ supplements..
Patient was concerned about poor prognosis and due to financial issues he was shifted to our hospital on 22/11/21 .
On the day of admission Patient vitals were checked and ET tube was changed on 23/11/21 tracheostomy was done .
Central line treatment is done .
Past history:
No history of chest pain ,Hypertension palpitations ,
no history of diabetes,epilepsy,TB,tyroid disorder.
Personal history:
Diet-mixed
Appetite- None
Bowel and bladder- Regular
Sleep-normal
Addictions - Alcohol - Every day
Family history:
No history of DM/HTN/TB/ asthma/ thyroid
No similar complaints in the family previously .
General examination:
No pallor or cyanosis Or icterus or clubbing
No lymphadenopathy
Malnutrition is observed ,
No Dehydration or odema
Vitals:
Temp -98.4 C/F
Pulse rate -82 /min
Resp ratec-16/min
Bp-160/110 mm hg
Spo2-99%
GRBS - 114 mg%
Systemic examination:
1.cvs-inspection-chest wall is bilateral systemically
Palpation -normal
Auscultation-normal with regular heart beat
S1 S2 heard
No murmurs
2.respiratory system:
Position of trachea-central,normal bilateral air entry,no Av sound
Breath sound is vascular
3.abdomen
Shape of abdomen is scaphoid
No tenderness
No palpable mass
Liver is palpable
Bowel sounds are heard
Investigations
Treatment:
On 22/11/21
Inj .Buphinorphin 150 ml IM
Inj . Augmentin IV BD
Inj .Metrogyl IV TID
Inj .Pam IV BD
On 23/11/21
Inj .Pam IV BD
Inj . Glycopyrolax IM BD
Inj . NAC IV BD
Inj . PAN IV OD
Inj . Optinuron IV OD
Inj . Augmentin IV BD
Inj .Metrogy IV TID
Syp Potklos
Inj lasix IV
24/11/21
Inj .Pam IV BD
Inj . Glycopyrolax IM BD
Inj . NAC IV BD
Inj . PAN IV OD
Inj . Optinuron IV OD
Inj . Augmentin IV BD
Inj .Metrogy IV TID
Injsodo NICORB IV
Questions
1. What are the main complications of OP poisoning ??
2. What is the drug of choice for OP poisoning ?
3.What is the mechanism of action of Atropine and Pralidoxime ?
4.How does organophosphate affect the nervous system?
5. How long does the effects of OP Last?
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