Résumé
A 19 year young male who consumed organophosphorous compound and required assisted mechanical ventilation for two weeks, later on developed delayed neuropathy is described.
Sujets)
Adulte , Humains , Insecticides/intoxication , Mâle , Composés organiques du phosphore/intoxication , Polyneuropathies/induit chimiquement , Ventilation artificielle , Paralysie des muscles respiratoires/induit chimiquement , Tentative de suicide , Facteurs tempsRésumé
In severe form of tetanus, even with maximum dose of muscle relaxants, spasms and apnoeic spells may persist and that may be life-threatening. The aim of this study was to assess the effect of neuroparalysing the patients and then providing ventilatory support in bringing about their recovery. Forty-nine adult patients of severe tetanus (Ablett's grade IIIA--6 patients and Ablett's grade IIIB--43 patients) were studied during the period from April, 1993 to February, 1996. Mean period of onset ie, period from trismus to first spasm, in these patients was 24 hours. Patients were neuroparalysed with a bolus dose of 2-4 mg of pancuronium followed by a continuous infusion of 1-2 mg/hour and simultaneously supported with mechanical ventilation until spasms subsided. Fourteen patients (28.6%) survived and rest died. Mean duration of ventilatory support on survived patients was 14.4 days. The commonest complication encountered during ventilatory support was respiratory tract infection observed in 36 patients (73.5%). Commonest cause of death was autonomic imbalance encountered in 15 patients (30.6%). Treatment of choice in severe tetanus should be neuroparalytic ventilatory support. With use of new generation ventilators and better intensive care facility, death in severe tetanus is likely to be very less.
Sujets)
Adolescent , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Pancuronium/usage thérapeutique , Études prospectives , Ventilation artificielle/méthodes , Insuffisance respiratoire/étiologie , Paralysie des muscles respiratoires/induit chimiquement , Spasme/traitement médicamenteux , Tétanos/complicationsRésumé
Seventy two patients admitted to the Intensive Care Unit following ingestion of organophosphorus compounds were studied prospectively with two different doses of pralidoxime (PAM). One group received 1 gm immediately after admission and no further PAM and the other group received infusion of PAM, 1 gm 8 hourly for four days (total 12 gms). The incidence of type II paralysis or intermediate syndrome was 47%. We observed a higher incidence in the 4 days of infusion of PAM group (61%) (20 patients) as compared to the single Bolus dose group (39%) (13 patients). Relative risk 1.48 (confidence interval = 0.9-2.4).
Sujets)
Adulte , Réactivateurs de la cholinestérase/administration et posologie , Relation dose-effet des médicaments , Méthode en double aveugle , Calendrier d'administration des médicaments , Femelle , Humains , Perfusions veineuses , Mâle , Composés organiques du phosphore/intoxication , Mauvais usage des médicaments prescrits/traitement médicamenteux , Paralysie/induit chimiquement , Composés de pralidoxime/administration et posologie , Études prospectives , Paralysie des muscles respiratoires/induit chimiquement , SyndromeRésumé
A patient with severe organophosphorus poisoning is reported. He had coma and prolonged respiratory paralysis lasting 4 weeks and was treated successfully with 2347 mg of atropine, artificial respiration and supportive measures