PDF(Pubmed)
Abstract：
Organophosphate poisoning is a common, under-reported cause of attempted and completed suicide worldwide. Following the resolution of the acute cholinergic syndrome, patients may develop respiratory muscle and proximal limb weakness, known as intermediate syndrome. A young man was brought to our rural hospital unconscious, in extremis, due to organophosphate pesticide poisoning. He developed atypical intermediate syndrome with global paralysis, persistent fasciculations and prolonged cholinergic symptoms, differing from the recognised presentation. He was intubated for fifteen days in our newly developed intensive care unit. Limited treatment options and the absence of blood gases, electrolyte testing, ECGs, invasive monitoring and imaging, in conjunction with regular disruptions to electricity and oxygen, and complications including seizures and pneumonia, all made this prolonged intubation an ambitious and challenging endeavour. We offer learning points for the acute physician and rural intensivist, and a summary of our reflections and hints for best care when adapting to a resource-limited setting.
摘要：
有机磷中毒很常见,在全球范围内报道的自杀未遂和完全自杀的原因。急性胆碱能综合征消退后，患者可能会出现呼吸肌和近端肢体无力，被称为中间综合征。一个年轻人被带到我们农村医院昏迷，在极端情况下，由于有机磷农药中毒。他出现了非典型中间综合征伴全球瘫痪,持续的束颤和延长的胆碱能症状，与公认的演示不同。他在我们新开发的重症监护室插管了15天。有限的治疗选择和缺乏血气，电解质测试，心电图,侵入性监测和成像，结合对电力和氧气的定期中断，和并发症，包括癫痫发作和肺炎，所有这些都使这种长时间的插管成为一项雄心勃勃且具有挑战性的努力。我们为急症医生和农村重症医师提供学习点，以及我们在适应资源有限的环境时的思考和提示。
