Total duration of the study will be one year and all patients aged 12 years or older with clinical features of OP/carbamate poisoning requiring oxygen and atropine will be enrolled. Specific Objectives: To test whether salbutamol alters dose of atropine administered and incidence of tachydysrhythmias. Objectives:General Objectives: To test the efficacy of salbutamol at increasing oxygenation and speeding resuscitation. Research question: Will addition of the beta-adrenergic agonist salbutamol to atropine during resuscitation improve oxygenation, reduce the need for atropine, and speed stabilisation? A pilot clinical study is required to test the hypothesis and to provide data for powering a large phase III RCT. ![]() A single nebulised dose of the beta-adrenergic agonist salbutamol may increase removal since it increases alveolar fluid removal via the epithelial sodium channel. Therefore a treatment that increases removal, to complement atropine-induced cessation of production, could reduce fluid in the lungs and speed return effective oxygen exchange. Rationale: Atropine only stops production of fluid and does not speed its removal from the lung. It reported quicker stabilisation and a 14% absolute reduction in mortality. This study compared a faster 'doubling dose' method of atropinisation with a standard bolus method during resuscitation. A recent Bangladeshi RCT showed that rapid resuscitation of patients with atropine saves lives (6). Unfortunately, this treatment is often inadequate and many still die (5). ![]() On arrival at hospital, patients are resuscitated with atropine and, for OPs, an oxime AChE reactivator (4). ![]() These insecticides inhibit the enzyme acetylcholinesterase (AChE), producing an 'acute cholinergic crisis' with reduced consciousness, bradycardia, hypotension, and acute respiratory failure. The WHO now recognizes pesticide poisoning to be the single most important global means of suicide (2) Amongst pesticides, organophosphorus (OP) and carbamate insecticides are of most concern, causing about 2/3 of deaths (1,3). Most deaths occur in rural Asia where widespread use of pesticides to boost food production allows easy access at stressful times. Pesticide self-poisoning kills over 300,000 people every year (1). Why Should I Register and Submit Results?.However, two major barriers may limit these innovations, ethical issues associated with their clinical assessment in emergencies, and limited profitability in countries where most cases occur.Ītropine sulfate nerve agent organophosphates pesticides poisoning sarin soman tabun. This article intends to review recent advances in OP poisoning treatment, including agents investigated for their use as an alternative or adjunctive therapy, novel formulations such as nasal drops or sublingual tablets for emergency administration of atropine, as well as innovative strategies for enhanced oximes delivery and overall efficacy. Thus, recent research has focused on investigating novel approaches for their potential in improving current management strategies. Nevertheless, current treatment options are associated with several challenges. ![]() Additionally, current treatment guidelines recommend prompt administration of atropine as a first-line antidote, oximes as a follow-up, benzodiazepines for seizure control, and pyridostigmine for prophylaxis. Because itdoes not significantly relieve depression of respiratory center or decrease muscarinic effects of AChE poisoning, administer atropine concomitantly to block these effects of OP poisoning. Initial first-aid management involves decontamination, ventilation, and hemodialysis. Their vigorous permeability through inhalation, ingestion, and dermal exposure results in a high number of reported OP poisoning cases and alarming mortality rates. Organophosphorus agents (OP) are widely used as pesticides due to their cost effectiveness, yet they present a significant public health risk owing to their high toxicity, especially in cases of occupational exposure in agriculture, during suicide attempts using pesticides, and as nerve agents in warfare.
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