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.