INTRODUCTION :

Poisons are substances that are harmful when they get in to the body. Poisons also called toxins, toxic substances or hazardous substances. Poisoning occurs when a toxin is swallowed, breathed in, absorbed through the skin, injected, or gets in to the eyes. Poisoning can be a medical emergency, (Stanley.J. sweirzewski, 2008)

In Tamilnadu the incidence of poisoning was 75 per 100,000 population and the death rate was very high (22 per 100,000 population). The highest incidence in the age group was between15-34 and there were significant ethnic differences in the incidence of poisoning. About 67% of patients were developed major complication such as neurological seizures (23%), respiratory failure in 37% patients, 21% in various muscular deficits and others 29%. Agrochemicals were responsible for 59% of all poisonings. Parquet was the commonest poisoning agent with a high fatality rate of 68%, (Chadhurvedi, 2008).

Patients with poison exposure and toxicity may present with a spectrum of various clinical signs, symptoms and problems. Most of these are very easily anticipated, but others may be unpredictable or associated with exposure to unidentified substances that hinder the clinician from knowing what to expect. The poisoned patients have symptoms such as feeling sick, diarrhea, stomach pain, drowsiness, dizziness or weakness, high temperature of 38°C (100.4°F) or above, chills (shivering), loss of appetite, head ache, Irritability, difficulty swallowing, breathing difficulties, extreme tachycardia, producing more saliva than normal, skin rash, blue lips and skin, burns around the nose or mouth, double or blurred vision, mental confusion, seizures (fits),loss of consciousness, coma, hearing loss, (Horace. K. Liang, 1996).

Electrocardiographic changes are the most obvious marker of oleander poisoning. In oleander poisoning flattening or inversion of the T wave and depression of the ST segment, a prolonged PR interval or sick sinus syndrome, which may progress to conduction defects at the atrio-ventricular(AV) node consistent with severe poisoning. Deaths from ventricular fibrillation or a systolic arrests also present in such conditions. (Mollah .A.H, 2002).

NEED FOR THE STUDY:

Poisoning is a significant global public health problem. According to WHO data in 2009, an estimated one million people affected due to poisoning. Poisoning is the 6^th most common cause of death in India at the age group of 15-29 years of young adults. Approximately 600,000 people affected due to the after effect of poisoning, (WHO 2009).

A study is conducted among thirty nine OPCP patients (12.8%) included. The electrocardiographic findings seen in patients in order of frequency; sinus tachycardia(48.75), prolonged QT interval (20.5%), and right bundle branch block(20.5%), ST-T wave changes (12.8%), atrial fibrillation(7.7%), right axis deviation(5.1%), prolonged PR interval (2.5%), (Mesude Ath, 2013).

The another study is conducted to evaluate the electrocardiographical manifestations of organophosphate poisoning such as, sinus tachycardia, cardiogenic pulmonary edema and repolarization abnormalities, including ST segment elevation and T wave inversion as well as prolongation of QTc interval are most frequent cardiac manifestations. (Ghulam Hussain Balough,2012).

The ECG changes in other types of poisoning were unclear. The researcher had an interest to know the ECG changes in other common types of poisoning. The Dhanvantri Critical Care Centre is an hospital where 3 -4 patients are getting admitted with the complaints of different types of poisoning. The researchers had chosen this problem.

STATEMENT OF THE PROBLEM:

A descriptive study on electro cardio graphic changes among poisoned patients admitted in selected hospitals, erode

OBJECTIVES:

· To analyze the ECG changes among poisoned patients.

· To find out the association between ECG changes scores among poisoned patients with their demographic variables.

Assumptions:

· OPC poison which have a muscurnic and nicotinic effect. It releases acetyl cholinesterase which may cause severe respiratory arrest and cholinergic effects.

· Oleander has cardiac glycosides which may produce cardiac changes.

· Cow-dung poison contains pyritherine which may changes heart function.

· Celphos poison contains phosphine gas which may produce cardiac changes.

Hypotheses:

H₁: There is a significant difference in ECG changes among poisoned patients.

H₂: There is a significant association between ECG changes scores among poisoned patients with their demographic variables.

METHODOLOGY:

Design:

Descriptive research design was used.

Sample and number of samples:

60 poisoned patients were included from OPC, oleander, cow-dung and Celphos types

Sampling:

Purposive sampling technique was used.

Setting:

Poisoned patients of OPC, oleander, cow-dung and Celphos types who were admitted in Dhanvantri Critical Care Centre, Erode.

Tool:

ECG changes were analyzed by ECG Changes observational check list.

Table.1, ECG Changes observational check list

S.No	ECG changes	Present	Absent
1	Ventricular Tachycardia
2	ST-elevation
3	ST-depression
4	Sinus brady cardia
5	Prolong QTc interval
6	Prolong PR interval
7	Atrial tachy arrhythmia
8	Ventricular tachy arrhythmia
9	Atrial fibrillation
10	Bundle branch block
11	Normal sinus Rhythm
12	Ventricular premature complex

RESULTS:

Frequency and percentage of Electrocardiographic changes among OPC poisoned patients

Majority (93% and 73%) of OPC poisoned patients had Normal sinus rhythm and ventricular tachycardia. Similarly percentage (66% and 66%) of OPC poisoned patients had ST- elevation and Atrial Tachy arrhythmia. However 60%, of patients had Atrial fibrillation and more or less percentage (53%, 53% and 46%) of patients had ST-depression, prolong QTc interval and prolong PR interval respectively. Lowest percentage (40%and 33%) of patients had Ventricular tachy arrhythmia and ventricular premature complex. The results show that most of the OPC patients have Normal sinus rhythm (93%) and Ventricular tachycardia (73%) respectively.

Table.2.Frequency and percentage of Electrocardiographic changes among OPC poisoned patients (N₁=15).

S.No	Electrocardiographic changes	Frequency	Percentage
1	Ventricular Tachy cardia	11	73%
2	ST-elevation	10	66%
3	ST-depression	8	53%
4	Sinus bradycardia	-	-
5	Prolong QTc interval	8	53%
6	Prolong PR interval	7	46%
7	Atrial tachy arrhythmia	10	66%
8	Ventricular tachy arrhythmia	6	40%
9	Atrial fibrillation	9	60%
10	Bundle branch block	-	-
11	Normal sinus Rhythm	14	93%
12	Ventricular premature complex	6	40%

Table.3.Frequency and percentage of Electrocardiographic changes among Oleander poisoned patients (N₂ =15)

S.No	Electrocardiographic changes	Frequency	Percentage
1	Ventricular Tachy cardia	4	26%
2	ST-elevation	_	-
3	ST-depression	9	60%
4	Sinus bradycardia	15	100%
5	Prolong QTc interval	_	-
6	Prolong PR interval	_	-
7	Atrial tachy arrhythmia	8	53%
8	Ventricular tachy arrhythmia	1	6%
9	Atrial fibrillation	_	-
10	Bundle branch block	-	-
11	Normal sinus Rhythm	15	100%
12	Ventricular premature complex	_	-

All (100%) oleander poisoned patients had sinus bradycardia and normal sinus rhythm. However more or less (60% and 53%) of patients had ST-depression and atrial thacy arrhythmia respectively and 26% of them had ventricular tachycardia. Only 6% of patients had ventricular tachy arrhythmia.

Table.4. Frequency and percentage of Electrocardiographic changes among Cow-dung poisoned patients (N₃ =15).

S. No	Electrocardiographic changes	Frequency	Percentage
1	Ventricular Tachy cardia	5	33%
2	ST-elevation	_	-
3	ST-depression	6	40%
4	Sinus bradycardia	_	-
5	Prolong QTc interval	2	13%
6	Prolong PR interval	_	-
7	Atrial tachy arrhythmia	5	33%
8	Ventricular tachy arrhythmia	3	20%
9	Atrial fibrillation	_	-
10	Bundle branch block	-	-
11	Normal sinus Rhythm	4	26%
12	Ventricular premature complex	_	-

Majority (40%) of cow-dung poisoned patients had ST-depression, similarly percentage (33% and33%) of patients had Ventricular Tachycardia and Atrial Tachy arrhythmia respectively. However more or less similar percentage (26% and 20%) of patients had normal sinus rhythm and Ventricular Tachy arrythmia respectively. Lowest percentage (13%) of patients had Prolong QTc interval respectively. It shows that most of the Cow-dung poisoned patients had ST-depression (40%) and ventricular Tachycardia(33%) and Atrial Tachy Arrythmia (33%).

Table.5, Frequency and percentage of Electrocardiographic changes among Celphos poisoned patients (N₄=15).

S.No	Electrocardiographic changes	Frequency	Percentage
1	Ventricular Tachy cardia	5	33%
2	ST-elevation	6	40%
3	ST-depression	--	-
4	Sinus bradycardia	_	-
5	Prolong QTc interval	5	33%
6	Prolong PR interval	_	-
7	Atrial tachy arrhythmia	6	40%
8	Ventricular tachy arrhythmia	4	26%
9	Atrial fibrillation	9	60%
10	Bundle branch block	5	33%
11	Normal sinus Rhythm	_	-
12	Ventricular premature complex	_	-

Majority (60%) of celphos poisoned patients had Atrial fibrillation and similar percentage (40% and 40%) of them had atrial thacy arrthymia and ST-elevation). Similarly (33%, 33% and 33%) of patients had ventricular Tachy cardia, prolong QTc interval and Bundle branch block respectively. However, lowest percentage (26%) of patients had Ventricular Tachy arrythmia.

Findings related to analyze the Electrocardiographic changes among poisoned patients:

1. OPC poisoned patients:

Majority (93% and 73%) of OPC poisoned patients had Normal sinus rhythm and ventricular tachycardia.

2. Oleander poisoned patients:

All (100%) the oleander poisoned patients had sinus bradycardia and normal sinus rhythm.

3. Cow –dung poisoned patients:

Majority (40%) of cow-dung poisoned patients had ST-depression, similarly percentage (33% and33%) of patients had Ventricular Tachycardia and Atrial Tachy arrhythmia respectively.

4. Celphos poisoned patients:

Majority (60%) of celphos poisoned patients had atrial fibrillation and similar percentage (40% and 40%) of them had atrial tahcyarrthymia and ST-elevation).

Findings related to association between ECG changes scores among poisoned patients with their demographic variables:

OPC poison:

Chi –square value for age in years was 0.51.

Chi –square value for gender was 0.12.

Chi –square value for socio-Economic status was 0.61.

Chi –square value for residence was 0.02.

Chi –square value for Education was 0.63.

Chi –square value for Marital status was 1.75.

Chi –square value for First Aid Measures was0.71.

Chi –square value for Associated factors was 0.93.

Oleander poison:

Chi –square value for age in years was 3.61.

Chi –square value for gender was 1.60.

Chi –square value for socio-Economic status was 1.04.

Chi –square value for residence was 0.13.

Chi –square value for Education was 3.87.

Chi –square value for Marital status was 1.51.

Chi –square value for First Aid Measures was 0.6.

Chi –square value for Associated factors was 0.

Cow-dung poison:

Chi –square value for age in years was 5.91.

Chi –square value for gender was 1.53.

Chi –square value for socio-Economic status was 10.12.

Chi –square value for residence was 0.22.

Chi –square value for Education was 22.66.

Chi –square value for Marital status was17.71.

Chi –square value for First Aid Measures was 8.61.

Chi –square value for Associated factors was 0.

Celphos poison:

Chi –square value for age in years was 11.37.

Chi –square value for gender was 2.26.

Chi –square value for socio-Economic status was 6.15.

Chi –square value for residence was 5.51.

Chi –square value for Education was 4.61.

Chi –square value for marital status was 9.61.

Chi –square value for First Aid Measures was 6.02.

Chi –square value for associated factors was 1.02.

CONCLUSION:

H₁: There is a significant difference in ECG changes among poisoned patients. So, this hypothesis is accepted.

H₂: There is a significant association between ECG changes scores among poisoned patients with their demographic variables. So this hypothesis was rejected.

REFERENCES:

1. www.ECG.com

2. www.cnn.com

3. www.wikipedia.org

4. www.msn.com

5. www.naturalnews.com

6. www.answer.com

Received on 11.08.2014 Modified on 12.09.2014

Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 309-312