CARDIAC ARREST FROM OVERDOSE.ppt

CARDIAC ARREST FROM OVERDOSE All patients should have: DECONTAMINATION of the GIT CORRECTION of ELECTROLYTES abnormalities CARDIOVERSION when appropriate OXYGENATION and protection of airway CONSULTATION WITH THE CLINICAL PHARMACOLOGIST Successful resuscitation has been well documented after 8 hours of CPR CARDIAC ARREST FROM OVERDOSE Overdose patients may have: a reversible cause for their arrest good general health novel treatments for arrhythmias cerebral protection CARDIAC ARREST FROM OVERDOSE The major causes of cardiac arrhythmia in our area are: QUINIDINE-LIKE DRUGS SYMPATHOMIMETIC DRUGS CALCIUM CHANNEL BLOCKERS BETA BLOCKERS DIGITALIS CHLOROQUINE Arrhythmias may also be secondary to metabolic/electrolyte abnormalities eg salicylates, methanol, ethylene glycol QUINIDINE-LIKE DRUGS TRICYCLIC ANTIDEPRESSANTS PHENOTHIAZINES QUINIDINE PROCAINAMIDE DISOPYRAMIDE QUININE SYMPATHOMIMETIC DRUGS INCREASED SENSITIVITY TO CATECHOLAMINES CHLORAL HYDRATE THEOPHYLLINE INCREASED CATECHOLAMINES AMPHETAMINES COCAINE THEOPHYLLINE BETA AGONISTS Arrhythmias normally respond to beta blockade (propranolol) CHLORAL HYDRATE OVERDOSE Grandfather drug hypnotic 1869 1890 review of the first 44 deaths death = tricyclics Prodrug with enhanced formation of active tichloroethanol by alcohol Rapid absorption with peak levels 0.5-1 hour Deaths as little as 2-3 grams in adults (5-10 grams more commonly) Recreational and inappropriate use Trichloroethanol T1/2 between 8 to 35 hours sensitises myocardium to catecholamines. CALCIUM CHANNEL BLOCKERS HYPOTENSION Peripheral vasodilatation myocardial depression Volume expansion (normal saline) Calcium gluconate (1-4 ampoules) BRADYARRHYTHMIA Ca++ (4-8 ampoules) Adrenaline, isoprenaline, dopamine infusion Correct acidosis if pH7.2 Pacemaker if 2nd degree heart block or above CHLOROQUINE Features of toxicity may develop within 30 minutes death may occur within 3-4 hours myocardial depression arrhythmia. TOXICOKINETICS RAPIDLY ABSORB