organophosphorous poisoning and opioid intoxication
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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

ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION

Presenter : Dr. Sunil

Moderator : Dr. V. Darlong

www.anaesthesia.co.inanaesthesia.co.in@gmail.com

slide3
Irreversible anticholinesterases

Organo phosphates Carbamates

Dyflos Carbaryl

Echothiophate Propoxur

(Baygon)

Para, Malathion,

Diazinon (TIK 20)

Tabun, serin(Nerve gas)

absorption
ABSORPTION
  • Inhalational
  • Dermal
  • mucous membrane
  • GIT
slide6
Suicidal
  • Agricultural exposure
  • nerve gas in bio warfare

Hydrocarbon solvent

slide7

SYMPTOMS & SIGNS

  • Muscarinic
  • SLUDGE – Salivation, lacrimation, urination, diarrhoea, gastric upset, emesis
  • Miosis,
  • decreased HR, BP
  • Pulmonary edema, aspiration pneumonia
  • chemical pneumonitis, ARDS
  • Chromolachryorrhoea
slide8
Nicotinic
    • Skeletal Muscle
      • Fasciculation
      • Paralysis
    • Sympathetic Ganglion
      • BP
      •  HR
      • mydriasis
slide9

SYMPTOMS (Contd…)

  • CNS
  • Slurred speech, delirium, seizure coma, resp depression
  • Other
    • HONK, glucosuria, Hyperamylasemia (pancreatitis)
  • Chronic
    • Peripheral N. memory impair, depression
slide10
Fatal dose
  • Para (80mg, 175mg) Malathion (1g)

Fatal period

  • 24 hr, 10 days

Cause of death

  • Resp. arrest
slide11
Diagnosis
  • Plasma cholinesterase (40-140-IU/L)
    • Mild :20-50%
    • Moderate : 10-20%
    • Severe : <10 %
  • Clinical improvement preceeds decrease in levels
  • Atropinization (2mg)
management
MANAGEMENT
  • Supportive
    • ABC, Decontamination
    • Gastric lavage (<1hr) KMnO4 1:10,000
    • Emesis : C/I
    • A:C 25g, 4 hr.ly Thrice
    • ABG, QTc 
slide13
Specific
    • Atropine
      • Benzyl alc
      • 2mg iv. Ev 10 m
      • Atropinizan
      • Taper slowly overs few days
  • Intermediate syndrome
slide14

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
slide15
Seizure
    • BZD
    • phenytoin
  • Hemoperfusion
    • Parathion
opioids classification
Opioids - Classification
  • Natural Synthetic
    • Morphine Morphinans - Butorphanol
    • Codiene Diphenylpropylamine - methadone

Benzomorphan - pentazosine

Phenylpiperidine - meperidine, fentanyl

  • Semi-synthetic
    • Heroin
    • Dihydromorphone
opioid intoxication
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
management1
MANAGEMENT
  • ABC, monitoring, ABG
  • Emesis C/I
  • Gastric lavage < 1hr, even injected, KMnO4 1:10,000
  • AC 25 g, 4 hrly, Thrice
management contd
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
body packers
BODY PACKERS
  • Whole bowel irriga
  • Intestinal obst. Surgery
  • No endoscopic removal
  • ICU, monitoring- R.R. Consciouness level

(Till all packet passed)

  • Serial CT Scan
slide21
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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