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ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION

ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION . Presenter : Dr. Sunil Moderator : Dr. V. Darlong . www.anaesthesia.co.in anaesthesia.co.in@gmail.com. ORGANOPHOSPHOROUS POISONING . Irreversible anticholinesterases Organo phosphates Carbamates Dyflos Carbaryl

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ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION

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  1. ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION Presenter : Dr. Sunil Moderator : Dr. V. Darlong www.anaesthesia.co.inanaesthesia.co.in@gmail.com

  2. ORGANOPHOSPHOROUS POISONING

  3. Irreversible anticholinesterases Organo phosphates Carbamates Dyflos Carbaryl Echothiophate Propoxur (Baygon) Para, Malathion, Diazinon (TIK 20) Tabun, serin(Nerve gas)

  4. ABSORPTION • Inhalational • Dermal • mucous membrane • GIT

  5. Mechanism of action

  6. Suicidal • Agricultural exposure • nerve gas in bio warfare Hydrocarbon solvent

  7. SYMPTOMS & SIGNS • Muscarinic • SLUDGE – Salivation, lacrimation, urination, diarrhoea, gastric upset, emesis • Miosis, • decreased HR, BP • Pulmonary edema, aspiration pneumonia • chemical pneumonitis, ARDS • Chromolachryorrhoea

  8. Nicotinic • Skeletal Muscle • Fasciculation • Paralysis • Sympathetic Ganglion • BP •  HR • mydriasis

  9. SYMPTOMS (Contd…) • CNS • Slurred speech, delirium, seizure coma, resp depression • Other • HONK, glucosuria, Hyperamylasemia (pancreatitis) • Chronic • Peripheral N. memory impair, depression

  10. Fatal dose • Para (80mg, 175mg) Malathion (1g) Fatal period • 24 hr, 10 days Cause of death • Resp. arrest

  11. Diagnosis • Plasma cholinesterase (40-140-IU/L) • Mild :20-50% • Moderate : 10-20% • Severe : <10 % • Clinical improvement preceeds decrease in levels • Atropinization (2mg)

  12. MANAGEMENT • Supportive • ABC, Decontamination • Gastric lavage (<1hr) KMnO4 1:10,000 • Emesis : C/I • A:C 25g, 4 hr.ly Thrice • ABG, QTc 

  13. Specific • Atropine • Benzyl alc • 2mg iv. Ev 10 m • Atropinizan • Taper slowly overs few days • Intermediate syndrome

  14. PAM • Started within 24 hrs • 1 - 2g 100 ml NS over 30 min • 6 - 12 hourly, 12 g / day • 500 mg / hr Infusion • 20 - 40 mg / kg

  15. Seizure • BZD • phenytoin • Hemoperfusion • Parathion

  16. Opioids - Classification • Natural Synthetic • Morphine Morphinans - Butorphanol • Codiene Diphenylpropylamine - methadone Benzomorphan - pentazosine Phenylpiperidine - meperidine, fentanyl • Semi-synthetic • Heroin • Dihydromorphone

  17. OPIOID INTOXICATION Accidental, iatrogenic, suicidal, drug abuser, body packer Symptoms and signs • Resp. Depress, Coma, Pinpoint pupil, cyanosis, N/v, seizure • Hypotension Bradycardia pulm. Edema • Human fatal dose : 250 mg morphine i.m. • Cause of death : Resp. fail

  18. MANAGEMENT • ABC, monitoring, ABG • Emesis C/I • Gastric lavage < 1hr, even injected, KMnO4 1:10,000 • AC 25 g, 4 hrly, Thrice

  19. MANAGEMENT (Contd…) Naloxone • 0.4 mg IV  0.8 after 2 min • Rept. Till recovery or total 10 mg • S.L. E.T, I.N • T ½ (30-45 m) • Inf. (2/3 initial dose hrly, Twice i.m. 4-5 /kg/hr) • Neonate 10 /kg Rpt. 2 min, 60 /kg Naltrexone • P.O. Maintenance, 25-30mg/day, T ½ 24 hrs • Nal mefene: T ½ 10.8 hrs, 4 mg single dose

  20. BODY PACKERS • Whole bowel irriga • Intestinal obst. Surgery • No endoscopic removal • ICU, monitoring- R.R. Consciouness level (Till all packet passed) • Serial CT Scan

  21. UROD • Anaesthesia assisted • Controversial – Sudden deaths , poor supportive evidence (O Conner PG, Kosten TR 1998; JAMA) www.anaesthesia.co.inanaesthesia.co.in@gmail.com

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