Care of patient with OPC poisoning

Sivagami. C

Assistant Nursing Superintendent, Department of Nursing, Kauvery Hospital, Salem

Correspondence: M: +91-9578970004; Email: csivagamisanjeevi@gmail.com

Abstract

Organophosphate poisoning is poisoning due to organophosphates that are used as insecticides, medications, and nerve agents. Organophosphate (OPC) poisoning continues to be a frequent reason for admission to hospitals and Intensive Care Units. The poison affects both sympathetic and parasympathetic nervous systems.

Presenting manifestations of poisoning are increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion

Case presentation

A 55 years aged male, with alleged history of consuming organophosphate poison (Dimethoate) 200ml at 3.20pm on 04.05.2024, was brought to ER at 5pm.

On arrival, patient was very drowsy.

Day – 1, 2, 3

Vitals

  • BP – 80/50mm Hg
  • P/R – 142 min
  • R/R – 25 min
  • SpO2 – 90%

 

Nursing Care

Emergency intubation was done. Gastric lavage was given.

Patient was placed on mechanical ventilator, VC mode.

NPO

IVF: DNS/RL 125ml/hr

Vitals

  • BP – 110/70 mm Hg (On Inj. Norad 10ml support which was tapered according to patient condition)
  • P/R – 132 min
  • R/R – 26 min
  • SpO2 – 100 % with FIO2 – 40%

Infusion

  • Atropine 1ml/hr
  • Pralidoxime 20ml/hr
  • Midazolam + Inj. Fentanyl 5ml/hr

Day – 4

Patient was conscious

Febrile – Temp: 99°F

Patient on T. Piece with 2l O2

IVF on flow 125ml/hr DNS

Plan weaning

Extubation trial given after chest physio and adequate suctioning. Neb Budecort given

IVF 75ml/hr

RT feed removed

Oral feed started

Nursing Care

  • Mobilization
  • Spiro meter exercise
  • Back care
  • Chest physio
  • Physiological given support

Day – 5

  • Patient was febrile
  • Psychiatrist opinion obtained
  • Counseling given and medication added Tab. Oleanz 5mg 0-0-1

Primary consultant and Intensivist advised to shift to patient to ward

Patient shifted to ward

Discharge Advice

DrugDoseFrequencyDuration
Tab. Ultracet 1-0-13days
Tab. Zincovit 1-0-015 days
Tab. Pan40mg 0-0-11week
Tab. Olenz5mg0-0-110days
Tab. Anxit 0.5g 0-0-110days

Review in psychiatrist OPD after 1 week.

Conclusion

However, the patient was critical on arrival, appropriate nursing care along with the interventions and continuous monitoring improved the prognosis of the patient.

Ms. Sivagami. C
ANS, Department of Nursing

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