Document Fragment View

Matching Fragments

After 7.45 a.m. on 19/05/02 half hourly Atropine injection was not given and Atropine by continuous infusion was stopped at 10 a.m. on that day. At 10.20 p.m. on 19/05/02 the patient had a temperature of 105 degree Fahrenheit and had tachycardia. Blood slides for malaria parasite was considered and Paracetamol injection was suggested. A consideration for transfer to I.T.U. was noted. Treatment chart shows that injection Paracetamol was given. At 12.20 a.m. the patient was noted to have severe respiratory distress with a fever of 104, respiratory rate of 60/minute and heart rate 180/minute. The condition of the patient was explained to her relatives and also the prognosis was explained. The patient was received in I.T.U. at 1.10 a.m. on 20/05/02 where she was found deeply comatosed, but not cyanosed and she was not responding to pain stimuli. Chest examination revealed bilateral coarse, crepitations. The pupils were dilated and there was no neck stiffness. She was put on ventilatory support and her oxygen saturation was found to be 100%. Chest examination revealed crepitations. At 2 a.m. on 20/05/02 she was started on dobutamine infusion for her low blood pressure. At 2.15 a.m. her cardiac monitor showed a systole. At 2.45 a.m. she had continued supra ventricular tachycardia with a systolic blood pressure of 60 mm Hg. Resuscitation attempts were unsuccessful and she was declared clinically dead at 3 a.m. on 20/05/02. The admission sheet shows that she was admitted on 18/05/02 and expired on 20/05/02 and that the final diagnosis was organophosphorus poisoning and supra ventricular tachycardia. The text book and medical reference clearly say that the patient with a history of poisoning by this group of substances can relapse and even die after initial stabilization by anti-dotes. The main cause for worry was respiratory muscle paralysis leading to death. In this type of cases the stomach of the patient has to be kept empty so that there is no occurrence of vomiting and aspiration causing respiratory problem. The injection Atropine was the specific anti-dote in this type of cases. In some cases very high dose of Atropine may be required depending on the degree of poisoning and duration of exposure to it.