Chenoweth James A, Colby Daniel K, Sutter Mark E, Radke Joshua B, Ford Jonathan B, Nilas Young J, Richards John R
Department of Emergency Medicine, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States; Division of Toxicology, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States.
Department of Emergency Medicine, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States; Division of Toxicology, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States.
Am J Emerg Med. 2017 Oct;35(10):1581.e3-1581.e5. doi: 10.1016/j.ajem.2017.07.023. Epub 2017 Jul 6.
The management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion. The patient experienced refractory bradydysrhythmia that responded only to transvenous pacing. Extracorporeal life support was initiated and resulted in successful organ perfusion and complete recovery of the patient. This case highlights the potential utility of extracorporeal life support in cases of severe toxicity due to multiple cardioactive medications.
在急诊科处理心脏活性药物过量情况可能具有挑战性。一种或多种心脏活性药物的严重毒性逆转可能使最大程度的药物治疗失效，并需要采取诸如经静脉心脏起搏和体外生命支持等极端侵入性措施。我们报告一例大剂量地尔硫卓和美托洛尔过量病例，该病例对包括静脉注射钙剂、胰高血糖素、血管加压药、高剂量胰岛素和脂质乳剂在内的最大程度药物治疗均无反应。患者出现难治性缓慢性心律失常，仅对经静脉起搏有反应。启动了体外生命支持，实现了成功的器官灌注，患者完全康复。该病例凸显了体外生命支持在多种心脏活性药物所致严重毒性病例中的潜在作用。
