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Table 1 An observation chart recording the initial atropinisation of an organophosphorus-poisoned patient

From: Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors

Initials XX

Study number Axxxx

Date of arrival xx/xx/xx

        

Time

Heart rate >80

Clear lungs

Pupil size

Dry axilla

Syst. BP >80 mmHg

Bowel sounds (A/D/N/I)

Confused

Fever (>37.5°C)

Atropine infusion

Bolus given?

22.30

52

Creps+

Pinpoint

No

90/60

I

No

No

 

2.4 mg

22.35

60

Creps+

Pinpoint

No

90/60

I

No

No

 

4.8 mg

22.40

82

+/-

Pinpoint

Yes

110/60

N

No

No

 

4 mg

22.50

100

Wheeze

2 mm

Yes

-

D

No

No

 

2 mg

23.00

105

Clear

3 mm

Yes

-

D

No

No

2 mg/h

Infusion

23.15

105

Clear

3–4 mm

Yes

-

D

No

No

2 mg/h

Infusion

23.32

102

Clear

3–4 mm

Yes

-

D

No

No

2 mg/h

Infusion

00.30

98

Clear

3–4 mm

Yes

110/60

D

No

No

2 mg/h

Infusion

01.30

85

Clear

3–4 mm

Yes

-

D

No

No

2 mg/h

Infusion

02.30

72

Wheeze

3–4 mm

Yes

-

N/D

No

No

 

2 mg

02.35

96

Clear

3–4 mm

Yes

-

D

No

No

2.4 mg/h

Infusion

02.45

98

Clear

3–4 mm

Yes

-

D

No

No

2.4 mg/h

Infusion

04.00

102

Clear

3–4 mm

Yes

-

D

No

No

2.4 mg/h

Infusion

  1. Atropinisation was reached at 23.00, 30 min after the first atropine dose was given; a total of 13.4 mg of atropine was required. After 10 min, doubling doses were no longer used because there was a clear response to therapy with the pulse climbing above 80 beats/min and the chest sounding better. After a further 1.5 hours, the pulse rate started to drop but it was not until it had dropped below 80 beats/min and wheeze had become audible in the chest that another 2 mg bolus was given to atropinise the patient again. The atropine infusion rate was also increased and the patient remained stable for the next few hours.
  2. A/D/N/I, absent/decreased/normal/increased; creps, crepitations; syst. BP, systolic blood pressure. Clinical features in bold type indicate that atropine is required. Dashes indicate that no BP reading was taken.