2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Lavonas, Eric J.; Akpunonu, Peter D.; Arens, Ann M.; Babu, Kavita M.; Cao, Dazhe; Hoffman, Robert S.; Hoyte, Christopher O.; Mazer-Amirshahi, Maryann E.; Stolbach, Andrew; St-Onge, Maude; Thompson, Trevonne M.; Wang, George Sam; Hoover, Amber V.; Drennan, Ian R.; ,

doi:10.1161/cir.0000000000001161

Cited by 24 publications

(7 citation statements)

References 377 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In status epilepticus, guidelines recommend stabilizing the patient, monitoring vital signs and ECG, checking for blood glucose, collecting blood for electrolytes, hematology, toxicology screening, and (if appropriate) anticonvulsant drug levels [6]. CPR guidelines recommend considering naloxone in cardiac arrest patients with suspected opioid poisoning, even for lay responders [8]. In this study, naloxone was administered during CPR.…”

Section: Discussionmentioning

confidence: 98%

“…Neurons are vulnerable to hypoxia, and hypoxic brain damage may occur due to depressed respiration, which may result in seizures, coma, and stroke [7]. Naloxone is an opioid antagonist with a high affinity for the mu-opioid receptor, which allows for the reversal of opioid effects [8]. Loosely packed packets carried by body packers are highly susceptible to leakage and rupture [9].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Fatal Case of Opioid Body Packer Syndrome Presented with Seizures

Sarbay,

Şahin,

Beştemir

2023

globecc

View full text Add to dashboard Cite

Body packing" involves concealing drugs filled in packets inside the body to traffic illicit drugs. Packets may leak and rupture, which may have drug-induced toxic effects. We present a case of a 25-year-old male patient brought to the emergency department because of a seizure during an international flight. He was diagnosed with status epilepticus, and tracheal intubation was performed; however, he had a cardiac arrest shortly after. Pinpoint pupils and unclear patient history led to naloxone administration. After successful cardiopulmonary resuscitation, the patient was examined using computed tomography, which revealed multiple foreign bodies in the distal bowels. Blood toxicology tests were positive for opiates and negative for heroin metabolites, amphetamine, cocaine, barbiturate, and benzodiazepine. An emergency colonoscopy was performed, and the patient remained in the intensive care unit for 17 days before he died of to complications of Body Packer syndrome. Early diagnosis and appropriate management of this rare but potentially fatal condition are vital to improve patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Opioid Body Packer Syndrome Presented with Seizures

Sarbay,

Şahin,

Beştemir

2023

globecc

View full text Add to dashboard Cite

show abstract

“… 16 In the absence of hydroxocobalamin, it is advised to administer sodium nitrite for cyanide poisoning. 18 Sodium nitrite leads to higher methemoglobin levels compared to amyl nitrite, but this increase is associated with problematic low blood pressure. Accurate dosing of sodium nitrite is crucial in children and individuals with anemia to prevent excessive met hemoglobin formation.…”

Section: Discussionmentioning

confidence: 99%

Cyanide poisoning after bitter almond ingestion: “A rare case report”

Arabizadeh,

Mahmoudi,

Gandomani

et al. 2024

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageWe present a case of a 36‐year‐old woman with a history of three suicide attempts who had ingested approximately 40 bitter almonds in a suicidal act, leading to her admission to the emergency department of a regional hospital due to complaints of vomiting. Upon arrival, she exhibited confusion, and her vital signs were recorded as follows: pulse rate = 117 beats/min, blood pressure = 160/85 mmHg, oxygen saturation = 95%, respiratory rate = 16, temperature = 37°C. The patient venous blood gas analysis manifested severe metabolic acidosis (pH = 6.92, pO2 = 43 mmHg, HCO3 = 8.6 mmol/L, pCO2 = 42.7 mmHg, base excess = −25.9 mmol/L). Four hours later, she became unconscious and she was intubated. Gastric lavage and a single dose of 60 g of activated charcoal and sodium bicarbonate were administered. In the referral hospital, sodium nitrite was given due to the severity of the poisoning, and norepinephrine infusion was initiated to manage hypotension. Within a day, the patient regained consciousness, underwent extubation, and after 72 h was discharged and subsequently transferred to psychiatric care for further treatment. This case underscores the critical, life‐threatening implications of cyanide toxicity following the ingestion of bitter almonds, highlighting the efficacy of supportive measures such as gastric lavage, activated charcoal, and sodium bicarbonate. Furthermore, it emphasizes the successful application of sodium nitrite monotherapy in managing this condition.

show abstract

“…73,75,82,86 Severe opioid toxicity will initially present with respiratory depression leading to respiratory arrest followed by cardiac arrest. 76 The focus of treatment should be prompt recognition and activation of the emergency response system and administration of high-quality cardiopulmonary resuscitation (CPR). It is reasonable to administer naloxone to a child in respiratory arrest with a pulse in addition to standard basic life support/pediatric advanced life support (BLS/PALS) care.…”

Section: Pediatric Patients With Unwitnessed Opioid Ingestion May Pre...mentioning

confidence: 99%

“…It is reasonable to administer naloxone to a child in respiratory arrest with a pulse in addition to standard basic life support/pediatric advanced life support (BLS/PALS) care. [76][77][78][79][80][81] No studies demonstrate improved outcomes for administering naloxone during cardiac arrest and providing highquality CPR should be the initial focus of a child found to be in arrest.…”

Section: Pediatric Patients With Unwitnessed Opioid Ingestion May Pre...mentioning

confidence: 99%

Acute opioid overdose in pediatric patients

Sandelich,

Hooley,

Hsu

et al. 2024

JACEP Open

View full text Add to dashboard Cite

Recent increases in pediatric and adolescent opioid fatalities mandate an urgent need for early consideration of possible opioid exposure and specific diagnostic and management strategies and interventions tailored to these unique populations. In contrast to adults, pediatric methods of exposure include accidental ingestions, prescription misuse, and household exposure. Early recognition, appropriate diagnostic evaluation, along with specialized treatment for opioid toxicity in this demographic are discussed. A key focus is on Naloxone, an essential medication for opioid intoxication, addressing its unique challenges in pediatric use. Unique pediatric considerations include recognition of accidental ingestions in our youngest population, critical social aspects including home safety and intentional exposure, and harm reduction strategies, mainly through Naloxone distribution and education on safe medication practices. It calls for a multifaceted approach, including creating pediatric‐specific guidelines, to combat the opioid crisis among children and to work to lower morbidity and mortality from opioid overdoses.

show abstract

2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Cited by 24 publications

References 377 publications

A Fatal Case of Opioid Body Packer Syndrome Presented with Seizures

A Fatal Case of Opioid Body Packer Syndrome Presented with Seizures

Cyanide poisoning after bitter almond ingestion: “A rare case report”

Acute opioid overdose in pediatric patients

Contact Info

Product

Resources

About