Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Clin Toxicol (Phila) · Sep 2020
The association of cannabis use and cardiac dysrhythmias: a systematic review.
Introduction: Cannabis use results in elevation of heart rate and blood pressure immediately after use, primarily due to sympathetic nervous system stimulation and parasympathetic nervous system inhibition. These effects may precipitate cardiac dysrhythmia. The objective of our study was to analyze systematically the pertinent medical literature regarding the putative association between cannabis use and cardiac dysrhythmia. ⋯ Conclusion: Cannabis use is associated with increased risk of cardiac dysrhythmia, which is rare but may be life-threatening. Clinicians and nurses should inquire about acute and chronic cannabis use in their patients presenting with tachycardia, bradycardia, dysrhythmia, chest pain, and/or unexplained syncope. Patients who use cannabis should be educated on this deleterious association, especially those with underlying cardiac disease or risk factors.
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Clin Toxicol (Phila) · Sep 2020
Thromboelastometry (ROTEM) and thromboelastography (TEG) in copperhead snakebites: a case series.
Introduction: Copperhead snakes account for approximately half of treated snakebites in the US, and bites can result in significant swelling, bruising and pain. While other pit vipers, such as rattlesnakes, frequently cause coagulopathy demonstrated by standard coagulation tests including international normalized ratio (INR), partial thromboplastin time (PTT), platelet count, and fibrinogen, copperheads do not appear to do so. Functional coagulation tests, such as rotational thromboelastometry (ROTEM®) and thromboelastography (TEG®) illustrate the clotting process and may detect coagulation defects that were not evident on standard tests. ⋯ All four patients receiving ROTEM or TEG had normal values for ROTEM/TEG parameters and for standard coagulation tests. Conclusion: This corroborates previous research indicating that copperhead bites generally do not produce clinically significant coagulopathy. The role of thromboelastometry or thromboelastography in North American crotalid bites warrants further study.