Resuscitation
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We report the first case of sustained-release verapamil toxicity treated with Intralipid fat emulsion (IFE). Toxicity was confirmed by elevated serial serum verapamil and metabolite, norverapamil, levels. ⋯ Our patient was in shock despite standard therapy. No adverse events were noted and the patient fully recovered.
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Extracorporeal life support (ECLS) has been applied successfully to patients with acute cardiopulmonary failure. However, ECLS remains controversial for traumatized patients who are prone to bleeding. ⋯ Using ECLS to resuscitate traumatic respiratory distress proved to be safe and effective when conventional therapies had been exhausted. Early deployment of ECLS to preserve systemic organ perfusion, aggressive treatment of coexisting injuries and tailored anticoagulation protocols are crucial to a successful outcome.
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Letter Case Reports
Cardiac arrest after air travel successfully treated by presumptive fibrinolysis.
Thromboembolic events should be strongly suspected in cases where medical events occur after prolonged air travel. Pulmonary embolism should be suspected in patients with sudden cardiac arrest. Consequently, patients should be managed according to this eventuality. We report a case of sudden cardiac arrest after air travel in which the patient survived after fibrinolysis was prescribed on a presumptive basis.
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Randomized Controlled Trial Comparative Study
Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia.
The emergency treatment of supraventricular tachycardia (SVT) has, over the last two decades, changed from verapamil to adenosine primarily owing to documented hypotensive episodes occurring with rapid bolus infusions of the calcium channel blocker. Slow infusions of calcium channel blockers have not previously demonstrated hypotension to any significant degree. The aim of this study was to compare the efficacy and safety of bolus intravenous adenosine and slow infusion of the calcium channel blockers verapamil and diltiazem in the emergency treatment of spontaneous SVT. ⋯ Slow infusion of calcium channel blockers is an alternative to adenosine in the emergency treatment of stable patients with SVT. Calcium channel blockers are safe and affordable for healthcare systems where the availability of adenosine is limited.