TOX-ACLS: Toxicologic-oriented advanced cardiac life support
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Behavioral Health Emergencies
2023, Physician Assistant ClinicsAcute Cardiovascular Toxicity of Cocaine
2022, Canadian Journal of CardiologyCitation Excerpt :A prospective randomised controlled trial of patients with cocaine-associated chest pain found that lorazepam plus nitroglycerin was more effective at decreasing chest pain at 5 and 10 minutes after administration compared with nitroglycerin alone.66 Benzodiazepines are included as first-line therapy in patients with cocaine-associated chest pain, specifically in those patients manifesting features of increased sympathetic tone, including anxiousness, hypertension, and tachycardia.89,104 Nitroglycerin has been shown to decrease chest pain in patients presenting with cocaine-associated symptoms.55,66
Successful treatment of metoprolol-induced cardiac arrest with high-dose insulin, lipid emulsion, and ECMO
2015, American Journal of Emergency MedicineCitation Excerpt :This illustrates the need for medical interventions that reduce mortality in this population [7]. In massive overdose, traditional therapies such as glucagon, atropine, and vasopressors are insufficient; and circulatory device support, as well as high-dose insulin and intralipid therapies, may be indicated [8–16]. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides both circulatory and oxygenation support to restore perfusion in acutely poisoned patients, allowing for intrinsic metabolism and drug elimination [11].
Plant Toxins and the Heart
2015, Heart and ToxinsPediatric toxicology. Specialized approach to the poisoned child
2014, Emergency Medicine Clinics of North AmericaCitation Excerpt :The poisoned child in cardiac arrest or with severe hemodynamic compromise requires an approach that generally follows established American Heart Association guidelines for pediatric advanced life support.58 Occasional exceptions to this rule include the early use of sodium bicarbonate in advanced cyclic antidepressant (or other sodium channel blocking agent) toxicity or additional specific antidotal therapy for other cardiotoxic drugs, such as digitalis antibodies for severe digoxin overdose, glucagon for β-adrenergic blocker (BB) toxicity, and calcium and insulin/glucose therapy for severe calcium channel blocker (CCB) toxicity.59,60 For the child who has not arrested, but is in shock, the initial management usually begins with IV crystalloid fluids (eg, 20 mL/kg bolus, repeated and titrated to clinical effect), again followed by specific antidotes if such are appropriate.
Toxin-induced cardiovascular failure
2014, Emergency Medicine Clinics of North America