title: Early management after self-poisoning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors.
abstract: Severe organophosphorus or carbamate pesticide poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine best therapy. A cohort study of acute pesticide poisoned patients was established in Sri Lanka during 2002; so far, more than 2000 pesticide poisoned patients have been treated. A protocol for the early management of severely ill, unconscious organophosphorus/carbamate-poisoned patients was developed for use by newly qualified doctors. It concentrates on the early stabilisation of patients and the individualised administration of atropine. We present it here as a guide for junior doctors in rural parts of the developing world who see the majority of such patients and as a working model around which to base research to improve patient outcome. Improved management of pesticide poisoning will result in a reduced number of suicides globally.
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK. eddlestonm@eureka.lk
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.forename: Andrew
authors.initials: A
authors.lastname: Dawson
authors.forename: Lakshman
authors.initials: L
authors.lastname: Karalliedde
authors.forename: Wasantha
authors.initials: W
authors.lastname: Dissanayake
authors.forename: Ariyasena
authors.initials: A
authors.lastname: Hittarage
authors.forename: Shifa
authors.initials: S
authors.lastname: Azher
authors.forename: Nick A
authors.initials: NA
authors.lastname: Buckley
mesh_terms: D000208:Acute Disease; D001285:Atropine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002219:Carbamates / Q000506:poisoning*; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic; D062025:Organophosphate Poisoning; D010575:Pesticides / Q000506:poisoning*; D010808:Physical Examination; D011041:Poisoning / Q000628:therapy; D012151:Resuscitation; D013188:Sri Lanka
chemical_list: D002219:Carbamates; D010575:Pesticides; D001285:Atropine