Toxicologic issues during cardiopulmonary resuscitation

Abstract

It is important for providers to recognize the limitations of standard advanced cardiac life support algorithms when caring for poisoned patients. Toxicologic causes of cardiopulmonary compromise should be considered along with administration of appropriate antidotes and adjunctive therapies.

Hypotension and Shock in the Poisoned Patient

“…Interference with cellular physiology, metabolism, or receptor blockade in these poisonings frequently result in diminished effectiveness of standard advanced cardiac life support (ACLS) protocols, so antidotes or alternatives such as calcium, glucagon, high dose of beta-receptor agonists, insulin/glucose, or intravenous lipid emulsion therapy may be necessary [1]. Patients suffering from ventricular fibrillation or pulseless electrical activity should immediately undergo cardioversion or defibrillation.…”

“…While several large-scaled multicenter studies have changed the approach to the diagnosis and treatment of hypotension and shock in septic patients in recent years, the evidence base for the appropriate management of circulatory failure in poisoned patients is much more precarious. Toxicological research is often limited to case reports, small case series, or animal studies and most clinical recommendations or treatment guidelines are based on expert consensus or even personal experience rather than on criteria of evidencebased medicine [1]. Additionally, there may be a significant reporting bias from positive cases responding to different treatments, including extraordinary resuscitation measures.…”

Monitoring for overdoses

“…Whole-bowel irrigation using Golytely (2 l/h) can be used in instances of ingestion of sustained-release medications, iron, or entericcoated substances (Givens and O'Connell, 2007). The general rule is to give a 10:1 ratio of activated charcoal or 1-2 g/kg of body weight.…”

“…Beta blockers are more effective (Givens and O'Connell, 2007). Large doses of benzodiazepines are needed to treat the neurological symptoms of muscular rigidity and cardiovascular stimulation.…”