Case study organophosphorus

1. •
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
•
‫اشراف‬ ‫تحت‬
•
‫ا‬
.
‫د‬
/
‫زين‬ ‫محمد‬
.
‫باسيوط‬ ‫الصحة‬ ‫وزارة‬ ‫وكيل‬
•
‫د‬
/
‫جمال‬ ‫محمد‬
.
‫باسيوط‬ ‫العام‬ ‫االيمان‬ ‫مستشفي‬ ‫مدير‬
.
‫لسيادتكم‬ ‫مقدمة‬
:
‫ط‬
/
‫محمد‬
‫ربيع‬
‫احمد‬
‫طبيب‬
‫تخدير‬
‫والعناية‬
‫المركزة‬
.
‫العام‬ ‫االيمان‬ ‫مستشفي‬

2. Organophosphorus poisoning
case
Clinical approach and management

3. •
Male patient42 years old admitted to the emergency room on 6/10/2022.
•
Past history : free past medical history ,pt not known d.m or htn ,no history of previous
admission or surgeries.
•
Clinical presentation :pt presented dcl GCS:9/15,shocked and desaturated
•
History :
•
History from his family they claimed that he ingest (insecticide by mistake) and few minutes later
he suddenly begin to be confused,drowsy and later loss of consciousness .
•
Examination: pinpoint pupil
•
Bilateral basal crepetations by auscultation.
Patient
Presentation

4. •
Blood pressure 80/40
•
Pulse :120 /min, regular,weak,equal on both sides.
•
Temp :36.5
•
Respiratory rate :30/min
•
Oxygen saturation :85% on room air.
Vital signs

5. Investigations
Imaging
•
Chest x-ray was done on admission : show aspiration confirmed by c.t chest.
•
Ekg : sinus tachy

6. Labs on admission
•
Cbc :
•
Hb :12.5 mg/dl , Tlc : 6.8 , Lymph : 2 , Plt :167
•
S urea : 44 mg /dl S creatinine :1.1 mg/dl
•
Ast : 34 Alt : 11 Albumin :3.2 g/dl
•
Protein 5.5 INR : 1.13 Prothrombin time :13.3
•
Na :138 , K :3.7.
•
ABG on admission on RA : PH: 7.30 , Pco2 : 55 , Po2 : 65 , Hco3 : 24

7. Management
•
1-first goal in management is to prevent further exposure to the poisoning by
•
- carefully removing pt clothes and deliver it to the authority.
•
-gasric lavage was done and sent to forensic science lap for test.
•
2-ABC protocol :airway management,breathing (oxygen theraby) and circulatory
support by inotropes.
•
3-atropine injection.
•
4-PAM injection.

8. Pharmacological treatment
•
1- antibiotics Ceftriaxone 2g IV /24 hours

9. Progression 1
•
On day 2 of admission :
•
The pt show progress in oxygenation , descalating to Ventury 40 and oxygen
saturation is 97 % ,improvement of conscious level.
•
ABG : PH: 7.41, PCO2 : 35, PO2 : 68 , HCO3 : 22
•
Good urine output : 50 – 100 ml / h
•
Vital signs:

10. Progression 2
•
On day 4 of admission :
•
The pt is much more improve , descalating oxygen to ventury 24 and oxygen
saturation 94 % .
•
pt continue prone position .
•
we start chest physiotherapy .
•
Investigations : ABG accepted , S creatine : 1.3 , Urea : 50
•
Vital signs are stable , good urine output , investiagations accepted .
•
Follow up Ct chest was done : improved
•
Treatment : desclating steroids , continue other medications .

11. Progression 3
•
On day 6 on admission
•
Pt is now on simple oxygen mask and oxygen saturation 95%.
•
Not dyspnea or tachypnea , no fever .
•
Vital signs normal . Good urine output .
•
Investigations : D dimer : 0.3 , S ferritin : 250 , S creatinine :1.2 , Urea : 44 .
•
Treatment: descalating antibiotics , continue other medications .
•
Pt was discharged to ward and discharged home after 2 more days