Table 1

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

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

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.

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.

Eddleston et al. Critical Care 2004 8:R391   doi:10.1186/cc2953