Respiratory arrest as result of intravenous-oral self-poisoning with CNS depressants
INTODUCTION: Acute poisoning (AP) constitute 3% of all illness. A large number of AT has a leading psychiatric diagnosis (suicide). Mortality from AP on 3rd place after cardiovascular diseases and malignant diseases (WHO). AT followed by coma have smrtnost of 13-35%. Benzodiazepines, alone or in com...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Serbian Medical Society, Department of Emergency Medicine, Belgrade
2015-01-01
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| Series: | ABC: časopis urgentne medicine |
| Subjects: | |
| Online Access: | https://scindeks-clanci.ceon.rs/data/pdf/1451-1053/2015/1451-10531502030M.pdf |
| Summary: | INTODUCTION: Acute poisoning (AP) constitute 3% of all illness. A large number of AT has a leading psychiatric diagnosis (suicide). Mortality from AP on 3rd place after cardiovascular diseases and malignant diseases (WHO). AT followed by coma have smrtnost of 13-35%. Benzodiazepines, alone or in combination, account for 60% of all pharmacological poisoning. At high doses they do not depress the respiratory center, or in combination with other depressants can cause respiratory arrest. Benzodiazepines ultrashort facts as midazolam, quickly developing a coma, while midazolam and diazepam in therapeutic doses can cause respiratory arrest when administered intravenously quickly. Difficult AP with carbamazepine can cause coma, respiratory disorders to respiratory arrest, hypotension and development of cardiac arrhythmias, pulmonary edema and circulatory shock. This requires rapid implementation of reanimation measures at the scene of the incident. THE AIM: to point out that in the case a life-threatening poisoning CPR measures must be implemented at the place of accident by a trained and fully equipment personnel. MATERIALS AND METHODS: We used a retrospective analysis of medical records of EMS Vrbas and the Department of Toxicology of The Military Medical Academy. CASE REPORT: A woman aged 30, took with suicidal purposes an unknown quantity of medications and was found unconscious, cyanotic skin, hypotonic muscle, inmesurable blood pressure, soft, rapid carotid pulse and the occasional terminal inspirations, after which the breathing stops. She was, on the scene, endotracheally intubated, artificially ventilated, two intravenous lines placed and a fluid resuscitation with crystaloids was instigated with a dopamine stimulation. She was transported to the Clinic of Toxicology VMA, Beograd. She was a vitally stabile during transport. Toxicological findings proved presence of diazepam, midazolam and carbamazepine in blood. The sixth day she awakened from coma. She was discharged from hospital on the fifteenth day, without any new neurological deficits. She is alive UhI. IV. CONCLUSION: In the cases of severe poisonings survival depends on the equipment and the training of the physicians to perform techniques of ACLS at the place of the accident. Identification of poisoning etiological factors isn't necessary, usually its impossible and not crucial to the survival on the prehospital level. |
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| ISSN: | 1451-1053 2560-3922 |