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Table 2 Target end-points for atropine therapy

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

Clear chest on auscultation with no wheeze

Heart rate >80 beats/min

Pupils no longer pinpoint

Dry axillae

Systolic blood pressure >80 mmHg

  1. Notes:
  2. 1. The aim of atropine therapy is to clear the chest and reach the end-points for all five parameters.
  3. 2. There is no need to aim for a heart rate of 120–140 beats/min. This suggests atropine toxicity rather than simple reversal of cholinergic poisoning. Such high heart rates will cause particularly severe complications in older patients with pre-existing cardiac disease – myocardial infarctions may result. However, tachycardias are also caused by hypoxia, agitation, alcohol withdrawal, pneumonia, hypovolaemia, and fast oxime administration. Tachycardias are not a contraindication for atropine if other features suggest under-atropinisation.
  4. 3. Aspiration will commonly result in focal crepitations. Attempt to distinguish such crepitations from the more general crepitations of bronchorrhoea.
  5. 4. Splashes of organophosphorus into the eye will produce intense miosis that may not respond to atropine therapy. However, symmetrical miosis is likely to be due to systemic effects of the ingested pesticide.
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Critical Care

ISSN: 1364-8535