1/26. Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass.OBJECTIVE: To describe our experience with the use of percutaneous cardiopulmonary bypass as a therapy for cardiac arrest in an adult patient intoxicated with verapamil. DESIGN: Case report. SETTING: Emergency department of a university hospital. PATIENT: A patient with cardiac arrest after severe verapamil intoxication. INTERVENTIONS: Percutaneous cardiopulmonary bypass and theophylline therapy. CASE REPORT: A 41-yr-old white male had taken 4800-6400 mg of verapamil in a suicide attempt. On arrival of the ambulance physician, the patient was conscious with weak palpable pulses and was transported to a nearby hospital. The patient developed a pulseless electrical activity, and cardiopulmonary resuscitation was started. Despite all advanced life support efforts, the patient remained in cardiac arrest. Therefore, he was transferred under ongoing cardiopulmonary resuscitation to our department, where percutaneous cardiopulmonary bypass was initiated immediately (2.5 hrs after cardiac arrest). The first verapamil serum concentration obtained at admittance to our institution was 630 ng/mL. After several ineffective intravenous epinephrine applications, the administration of 0.48 g of theophylline as an intravenous bolus 6 hrs and 18 mins after cardiac arrest led to the return of spontaneous circulation. The patient remained stable and was transferred to an intensive care unit the same day. He woke up on the 12th day and was extubated on the 18th day. After transfer to a neuropsychiatric rehabilitation hospital, he recovered totally. CONCLUSION: In patients with cardiac arrest attributable to massive verapamil overdose, percutaneous extracorporeal cardiopulmonary bypass can provide adequate tissue perfusion and sufficient cerebral oxygen supply until the drug level is reduced and restoration of spontaneous circulation can be achieved.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/26. Cardiac asystole after mouthwash ingestion: a case report and review of the contents.In the search for intoxication, alcoholic patients often ingest toxic alcohols or other products containing ethanol. We report a patient who presented with intoxication from Listerine and rapidly progressed to cardiac asystole. Several mouthwash products have a high concentration of ethanol and are easily obtained. We review the contents of this product and their possible toxicologic effects.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/26. Aborted sudden death, transient Brugada pattern, and wide QRS dysrrhythmias after massive cocaine ingestion.Although cocaine is one of the leading causes of drug-related deaths, there is little clinical information describing the precise sequence of events leading to death in the cocaine intoxication. Usually, cocaine-related sudden deaths are unwitnessed, its electrocardiographic features are not attainable, and the majority of these patients have a rapidly fatal course and die before arriving at the hospital. We report a patient with massive cocaine ingestion who developed psychomotor agitation and generalized seizures followed by asystolic cardiac arrest. ventilation with supplemental oxygen by endotracheal intubation immediately restored spontaneous heart beat. After resuscitation, a severe metabolic acidosis (pH 6.65) and cardiac dysrrhythmias consistent with sodium channel poisoning were detected. The electrocardiogram showed accelerated junctional rhythm at 85 beats/min with right bundle branch block and left anterior hemiblock configuration, prolongation of QRS (0.16 sec) and QTc (0.52 sec) intervals, and terminal J wave associated with coved ST-segment elevation in leads V(1) and V(2) resembling the brugada syndrome. sodium bicarbonate administration was quickly followed by normalization of the cardiac conduction disturbances. This article discusses the clinical and electrophysiologic implications of these findings.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/26. Prehospital cardiac arrest in diabetic ketoacidemia: why brain swelling may lead to death before treatment.An adolescent is reported with type 1 diabetes mellitus and diabetic ketoacidemia (DKA) who died from brain herniation prior to treatment with intravenous fluids and intravenous insulin. The pathophysiology of raised intracranial pressure (ICP) and water intoxication is discussed. As DKA evolves, water and electrolyte losses are replaced by very hypotonic fluids taken orally, leading to a physiologic excess of free water that would cause brain swelling prior to treatment. central nervous system acidosis may interfere with normal compensatory mechanisms that help prevent small increases in ICP. The pathophysiology of pre-treatment brain swelling has important implications for rehydration with intravenous fluids and treatment with insulin. Prevention of DKA is paramount as well as complete postmortem evaluation of patients who die from this disease.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/26. Acute ethanol intoxication during pregnancy and consecutive fetal cardiac arrest: a case report.Chronic alcohol exposure during pregnancy and the resulting toxic effects for the fetus has been the subject of many investigations. In contrast, acute alcohol intoxication during pregnancy is a rare event and less is known about the consequences for fetal life. We report a case of the acute ethanol intoxication of a pregnant woman at the 35th week of gestation and the consecutive cardiac arrest of the neonate. Despite the life threatening event, the newborn recovered after resuscitation and intensive care treatment and could be discharged from hospital in good physical condition. We suggest that acute alcoholized pregnant women should be transferred to Perinatal Centers to cater for the possible need for emergency cesarean section and resuscitation of the newborn.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
6/26. death by quinine.We report a case of a man with a 9.75 g ingestion of quinine. The patient presented with recurrent pulseless wide complex tachycardia for which he received sodium bicarbonate, defibrillation and overdrive mechanical pacing. Despite treatment, the patient died. quinine is still available for the treatment of leg cramps and drug-resistant malaria. In overdose, quinine affects multiple organ systems, including vision, hearing, the cardiovascular, and renal systems. We review the current approach to quinine intoxication.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/26. Renal transplants from non-heart beating paracetamol overdose donors.INTRODUCTION: Non-heart beating donors (NHBD) are widely encouraged to avert the critical shortage in the kidney donor pool. Ischaemic injury at the time of cardiac arrest in the NHBD is more pronounced and therefore the kidneys resulting are considered marginal. This review describes our experience with four kidneys from two controlled NHBDs who were exposed to paracetamol intoxication and subsequently were treated with mannitol prior to organ donation. MATERIALS AND METHOD: Two patients with fulminant liver failure following paracetamol overdose were referred as 'withdrawal of treatment' NHBD. As the two patients had developed hepatic encephalopathy they were treated with mannitol to reduce intra-cerebral oedema. The two donors were oligoanuric for at least 24 h prior to cardiac arrest. Following cardiac arrest, in situ perfusion was carried out and the kidneys were removed. One pair of kidneys were machine perfused while the second pair of kidneys were cold stored prior to transplantation. RESULTS: Pre-transplant assessment of NHBD kidneys resulted in three of four kidneys being transplanted. The NHBD kidneys exhibited a period of delayed graft function (DGF). The early transplant biopsies showed evidence of diffuse cytoplasmic vacuolation. These histological features disappeared with time and the renal function improved until the time of discharge. DISCUSSION: Non-heart beating donor kidneys are considered marginal and the effect of mannitol and paracetamol drug intoxication will induce reversible sub-lethal injury. A period of dialysis is inevitable in clearing the reactive intermediates of mannitol and paracetamol. The kidneys behaved as traditional controlled NHBD at time of discharge.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
8/26. rewarming from severe accidental hypothermia with circulatory arrest.This case report demonstrates successful cardiopulmonary and cerebral resuscitation (CPCR) of a young male explored 15 hours following a suicide attempt (carbamazepine intoxication) in deep hypothermia (19 degrees C) with circulatory arrest. An extracorporeal circuit was used to rewarm the patient's blood. weaning from extracorporeal circulation (ECC) was successful and without complications as was recovery from multiorgan dysfunction, severe rhabdomyolysis and carbamazepine intoxication. An excellent outcome was achieved without any neurological deficit at the time of discharge from the hospital.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
9/26. Pseudolaminar necrosis in cyanide intoxication: a neuropathology case report.We describe the gross and microscopic neuropathological changes in the brain of a 17-year-old male who died 4 days after being poisoned with cyanide. Previous reports indicate that following cyanide intoxication, the brain develops diffuse hypoxic/ischemic changes, predominantly of the basal ganglia. The case we describe here had similar features but in addition showed striking laminar necrosis of the cerebral cortex. This finding in cyanide poisoning has been previously demonstrated by neuroimaging, but not pathologically.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
10/26. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature.BACKGROUND: Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. methods: A patient with hypothermic cardiac arrest, treated by the author using TL, serves as the basis for this report. A search of the English language literature using pubmed (National Library of medicine, Bethesda, maryland) was conducted from 1966 to 2003 and 13 additional patients were identified. Demographic information, lavage method, rewarming rate, complications, and neurological outcome were analysed. RESULTS: There were numerous causes for hypothermia, with drug and alcohol intoxication being the most common (n = 4; 28.6%). Patient age ranged from 8 to 72 years (median = 36 years). Mean core temperature was 24.5 /-0.60 degrees C. Most patients were without blood pressure or pulse upon presentation to the Emergency Department and the predominant cardiac rhythm was ventricular fibrillation (VF) (n = 9; 64.3%). Thoracic lavage was accomplished by thoracotomy in seven patients and tube thoracotomy in the remaining seven. Median rewarming rate was 2.95 degrees C/h. Median time until sinus rhythm was restored was 120 min. Median length of hospital stay was 2 weeks. Four (28.6%) patients died. Complications were seen in 12 (85.7%) patients. Among survivors, neurological outcome was normal in 8 (80%) while two were left with residual impairments. CONCLUSIONS: patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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