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Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Beta-adrenergic receptor antagonists (Beta blockers, BB) and calcium channel antagonists (calcium channel blockers) are common drugs that can produce profound cardiac depression and shock when taken in overdose.
A 20-something presented after a huge verapamil overdose in cardiogenic shock. And she does not know that this is an overdose; she thinks it is a patient with chest pain!! He was admitted to the ICU and was unstable, in shock, overnight. Verapamil overdose is complex and VERY dangerous. The initial K was 3.0
Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72
The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum SOFA Score: A Randomized Clinical Trial. PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Range 5 to 9) Etomidate: 7.0
The majority of local anesthetics have a common structure of a lipophilic aromatic ring, a hydrophilic amine group, and a linking group. [2] 2] This linking group can be either an amide (e.g., lidocaine) or an ester (e.g., 6] Action of local anesthetics is dependent upon the molecule crossing the plasma membrane in a unionized form. [2] mL/kg/min.
These findings are nearly pathognomonic of, or at least highly suspicious for, tricyclic antidepressant (TCA) overdose. One can read about management of TCA overdose in many places, and I have put some links to lifeinthefastlane below. We in emergency medicine obtain ECGs in overdoses mostly to look for TCA findings.
The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation.
Sodium bicarbonate is indicated for select patients including preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose. 18 ICUs participating in the ICU-RESUScitation Project (NCT02837497). However, many providers are still administering it for cardiac arrests even though we know it makes matters worse.
He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. In our case, the patient had accidentally overdosed on drugs prior to being found. His LMA is exchanged for an endotracheal tube without induction or paralytic agents.
In terms of clinical presentation it’s clear that it exists as a spectrum from mild to ICU level. This is one of those algorithms (like the CAM-ICU) that refuses to stay in my brain so invariably I end up looking it up. Overall expect to see this in 2 scenarios * the overdose of a single serotonergic agent – th.
Historically, iron toxicity and exposure affected children in unintentional overdose disproportionately. 1 The incidence of iron overdose and iron ingestion related deaths has significantly decreased over time, likely attributable to federal regulation. In severe toxicity, hematemesis, melena, or hematochezia may occur.
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