RESUMEN
We describe two cases of pulmonary edema, bradycardia, and hypotension associated with massive verapamil overdose. A noncardiogenic etiology of the pulmonary edema was indicated in one patient by normal thermodilution cardiac output and pulmonary artery occlusion pressure, and in the other patient by a normal echocardiogram. We hypothesize that calcium channel blocker overdose predisposes patients to develop pulmonary edema.
Asunto(s)
Bloqueadores de los Canales de Calcio/envenenamiento , Síndrome de Dificultad Respiratoria/inducido químicamente , Verapamilo/envenenamiento , Adulto , Bradicardia/inducido químicamente , Terapia Combinada , Cuidados Críticos , Sobredosis de Droga , Femenino , Humanos , Masculino , Síndrome de Dificultad Respiratoria/terapia , Intento de SuicidioRESUMEN
Cardiovascular deterioration after seizures in tricyclic overdose has long been suspected. The investigators studied a patient with a nortriptyline HCI level of 1,205 ng/mL who had four generalized grand mal seizures, each lasting between 60 and 90 seconds that were immediately followed by hypotension requiring norepinephrine support. When the seizures were controlled with midazolam, the hypotension subsided and norepinephrine was decreased. The metabolic acidosis associated with the seizures may have caused hypotension by direct cardiotoxicity, an increase in bioavailability of tricyclic antidepressant because of changes in protein binding, an alteration of the effects of tricyclic antidepressant on cardiac membrane sodium channels, or a combination of these mechanisms.
Asunto(s)
Hipotensión/inducido químicamente , Nortriptilina/envenenamiento , Convulsiones/inducido químicamente , Disponibilidad Biológica , Presión Sanguínea , Sobredosis de Droga/sangre , Sobredosis de Droga/complicaciones , Femenino , Corazón/efectos de los fármacos , Humanos , Hipotensión/diagnóstico , Hipotensión/tratamiento farmacológico , Hipotensión/fisiopatología , Midazolam/uso terapéutico , Persona de Mediana Edad , Norepinefrina/uso terapéutico , Nortriptilina/sangre , Nortriptilina/farmacocinética , Recurrencia , Convulsiones/tratamiento farmacológico , Canales de Sodio/efectos de los fármacos , Factores de TiempoRESUMEN
OBJECTIVES: To evaluate the success and complications of pulmonary artery catheterization via the femoral vein without the use of fluoroscopy, in the medical ICU. DESIGN: We retrospectively reviewed the charts of all patients receiving pulmonary artery catheters through the femoral vein in the medical ICU between July 1, 1988 and June 30, 1992. SETTING: Medical ICU at Bronx Municipal Hospital Center. PATIENTS: Thirty-three patients were studied (20 male and 13 female). The patients ranged in age from 24 to 83 years, with the mean age of 56 years. The condition at the time of catheterization was classified as septic shock (n = 22), gastrointestinal bleed (n = 7), cardiogenic shock (n = 1), cardiac tamponade (n = 1), preoperative (n = 1), or drug overdose (n = 1). MEASUREMENTS: In each case, pulmonary artery pressure tracings, electrocardiographic recordings, procedure, and nursing notes were reviewed from the time of catheter insertion. Charts were also analyzed for evidence of catheter-related septicemia, deep vein thrombosis, pulmonary embolism, or problems developing at the insertion site. RESULTS: Femoral vein pulmonary artery catheterization was performed successfully in 37 of 39 attempts (95 percent success rate) without the use of fluoroscopy. Five of the 33 patients studied had more than one femoral vein pulmonary artery catheter during their hospital course. Four of them had two femoral vein pulmonary artery catheters and the fifth patient had three femoral vein pulmonary artery catheters. Overall, 39 attempts at femoral vein pulmonary artery catheterization were made in the 33 patients studied. Three patients had 10- to 19-beat ventricular tachycardia (7.7 percent incidence) precluding catheter insertion via this approach in two instances. There was no clinical evidence of major hematomas or hemorrhages, catheter-related septicemia, deep vein thrombosis, or pulmonary emboli in any of our patients. CONCLUSION: Femoral vein pulmonary artery catheterization without the use of fluoroscopy is safe and effective.
Asunto(s)
Cateterismo de Swan-Ganz/efectos adversos , Cateterismo de Swan-Ganz/métodos , Vena Femoral , Arteria Pulmonar , Femenino , Fluoroscopía , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Taquicardia Ventricular/epidemiología , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the frequency and significance of aspiration and its clinical importance in patients with upper GI bleeding undergoing esophagogastroduodenoscopy in the ICU. DESIGN: Thirty consecutive patients with active and severe upper GI bleeding were studied. SETTING: ICU. PATIENTS: Ranged in age from 20 to 78 yr with an equal number of males and females. INTERVENTIONS: All patients had continuous pulse oximetry monitoring and had chest radiographs obtained less than 12 hr before endoscopy and less than 4 hr after endoscopy. MEASUREMENTS: Six (20%) of 30 patients developed new lung infiltrates after esophagogastroduodenoscopy. In this group of patients, preendoscopy chest radiographs were obtained after less than 4 hr. In five of these patients, infiltrates were accompanied by fever and/or leukocytosis and oxygen desaturation to less than 90% during the esophagogastroduodenoscopy. CONCLUSION: Clinically significant aspiration pneumonia frequently complicates esophagogastroduodenoscopy in upper GI bleeding patients and is an important mechanism of esophagogastroduodenoscopy-induced hypoxia.