heroin and Heart-Arrest

Topics: Analgesia; Analgesics; Animals; Blood Pressure; Cyclizine; Heart Arrest; Heroin; Humans; Injections, Intravenous; Methadone; Morphine; Myocardial Infarction; Nausea; Pain; Pentazocine; Pulmonary Circulation; Respiration; Shock, Cardiogenic; Spirometry; Vomiting

Naloxone is standard medication for the treatment of heroin intoxications. No large-scale studies have yet been carried out to determine its toxicity in heroin intoxications.. We have undertaken an investigation as to the frequency, type and degree of severity of complications attributable to naloxone administration. Subjects treated between 1991 and 1993 with naloxone for intravenous drug intoxications were prospectively evaluated.. Development of ventricular tachycardia or fibrillation; atrial fibrillation; asystole; pulmonary edema; convulsions; vomiting; and violent behavior within ten minutes after parenteral administration of naloxone.. Six of 453 intoxicated subjects (1.3%; 95% confidence interval 0.4%-3%) suffered severe adverse effects within ten minutes after naloxone administration (one asystole; three generalized convulsions; one pulmonary edema; and one violent behavior). After the ten minute period, no further complications were observed.. The short time between naloxone administration and the occurrence of complications, as well as the type of complications, are strong evidence of a causal link. In 1000 clinically diagnosed intoxications with heroin or heroin mixtures, from 4 to 30 serious complications can be expected. Such a high incidence of complications is unacceptable and could theoretically be reduced by artificial respiration with a bag valve device (hyperventilation) as well as by administering naloxone in minimal divided doses, injected slowly.

Topics: Adolescent; Adult; Aggression; Cocaine; Confidence Intervals; Drug Overdose; Female; Heart Arrest; Heroin; Humans; Illicit Drugs; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Naloxone; Narcotic Antagonists; Prospective Studies; Pulmonary Edema; Seizures; Substance Abuse, Intravenous

This case report describes the management of a patient, diagnosed with an intrauterine death at 31 weeks' gestation, who suffered a cardiorespiratory arrest during her induced labour while using a remifentanil PCA. She made a full recovery from resuscitation which included a peri-mortem caesarean section.

Topics: Adult; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Analgesics, Opioid; Cardiopulmonary Resuscitation; Cesarean Section; Codeine; Female; Fetal Death; Heart Arrest; Heroin; Humans; Labor, Induced; Piperidines; Pregnancy; Remifentanil; Young Adult

The survival to discharge rate after unwitnessed, non-cardiac out-of-hospital cardiac arrest (OHCA) is dismal. We report the successful use of therapeutic hypothermia in a 26-year old woman with OHCA due to intentional poisoning with heroin, amphetamine and insulin.The cardiac arrest was not witnessed, no bystander CPR was initiated, the time interval from the call to ambulance arrival was 9 minutes and the initial cardiac rhythm was asystole. Eight minutes of advanced cardiac life support resulted in ROSC.Upon hospital admission, the patient's pupils were dilated. Her arterial lactate was 17 mmol/l, base excess -20, pH 6.9 and serum glucose 0.2 mmol/l. During the first 24 hours in the ICU, the patient developed maximally dilated pupils not reacting to light and became increasingly haemodynamically unstable, requiring both inotropic support and massive fluid resuscitation. After 1 week in the ICU, however, she made an uneventful recovery with a Cerebral Performance Category of 1 at hospital discharge and at a follow up examination at 6 months.. According to most prognostic factors, the patient had a statistical chance for survival of less than 1%, not taking into account her severe state of hypoglyaemia. We suggest that this case exemplifies the need for more studies on the use of TH in non-coronary causes of OHCA.

Topics: Adult; Amphetamine; Brain Injuries; Female; Heart Arrest; Heroin; Humans; Hypoglycemia; Hypothermia, Induced; Insulin; Prognosis

We present the case of a 21-year-old female drug addict with severe accidental hypothermia (core body temperature 27.5 degrees C) and cardiorespiratory arrest. After successful cardiopulmonary resuscitation the patient was actively internally rewarmed without the use of extracorporal circulation. Although at the first clinical presentation the patient appeared to be dead, an excellent neurological outcome was achieved. This case report reviews the epidemiology, pathophysiology, prognostic markers and the therapeutic approaches of severe hypothermia.

Topics: Adult; Analgesics, Opioid; Cardiopulmonary Resuscitation; Drug Overdose; Female; Heart Arrest; Heroin; Heroin Dependence; Humans; Hypothermia; Prognosis; Rewarming

The survival of heroin overdose patients resuscitated from cardiac arrest is reported to be poor. The aim of our study was to investigate the outcome and characteristics of survivors after cardiac arrest caused by heroin overdose.. This was a retrospective study in a medium-sized city (population, 560,000). Between 1 January 1997 and 31 December 2000, there were 94 combined cardiac arrests caused by acute drug poisonings. The main outcome measure was survival to discharge.. Cardiopulmonary resuscitation was attempted in 19 heroin overdose patients (group A) and in 53 patients with cardiac arrest caused by other poisonings (group B). Three (16%) vs. six (11%) patients were discharged alive (group A vs. B, respectively). The survivors in group A had an Emergency Medical Service (EMS)-witnessed cardiac arrest or the Emergency Dispatching Centre was called before the arrest occurred. There was no statistically significant difference between the two groups in terms of survival. Survivors in both groups suffered from acute renal failure (two), hypoglycaemia (four) and hypothermia (three).. Survival after cardiac arrest caused by heroin overdose is possible if the arrest is EMS witnessed or the Emergency Dispatching Centre is called before the cardiac arrest occurs. In comparison with cardiac arrests caused by other poisonings, there was no difference in survival. The incidence and mechanism of hypoglycaemia should be examined in further studies.

Topics: Adult; Cardiac Output; Cardiopulmonary Resuscitation; Drug Overdose; Emergency Medical Services; Epinephrine; Female; Finland; Heart Arrest; Heroin; Heroin Dependence; Humans; Hypoglycemia; Male; Middle Aged; Narcotics; Rhabdomyolysis; Survival; Vasoconstrictor Agents

A case is reported of the Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation had been abandoned) in a patient following recreational drug use. The implications for management of cardiac arrest in the emergency department are discussed.

Topics: Adult; Cardiopulmonary Resuscitation; Cocaine; Emergencies; Heart Arrest; Hemodynamics; Heroin; Humans; Male; Remission, Spontaneous; Substance Abuse, Intravenous

We report on two patients with severe rhabdomyolysis and peripheral nerve involvement after drug intoxication. Nerve conduction studies of the paretic extremities of both patients could be performed within 12 h of the onset. Several nerves revealed evidence of conduction blocks in the paretic extremities. One of the patients who had taken heroin died and postmortem examination was performed. A drug-induced immune vasculitis could not be demonstrated. Besides striated muscle necrosis, extensive myocardial fragmentation was shown. Territorial ischemia, resulting from systemic hypotension and mechanical compression of arteries, seems to have been the cause of the myonecroses and peripheral nerve damage in the unconscious patients.

Topics: Adolescent; Adult; Cannabinoids; Ethanol; Fatal Outcome; Female; Flunitrazepam; Heart Arrest; Heroin; Humans; Illicit Drugs; Ischemia; Leg; Male; Muscle, Skeletal; Neurologic Examination; Peripheral Nerves; Psychotropic Drugs; Rhabdomyolysis; Substance-Related Disorders; Synaptic Transmission

A 31-year-old woman had an elective Caesarean section under combined spinal/epidural anaesthesia. At the end of the operation, diamorphine 2.5 mg in 5 ml of 0.25% bupivacaine plain was injected through the epidural catheter. Forty minutes after this, the patient had a cardiorespiratory arrest in an ordinary postnatal ward.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Bupivacaine; Cardiopulmonary Resuscitation; Cesarean Section; Female; Heart Arrest; Heroin; Humans; Pregnancy

The mortality rate from heroin overdose in Italy between 1977 and 1987 increased significantly. However, in the same period, a significant increase was not observed in Tuscany, an administrative region in Italy. This study was performed to determine if the prehospital emergency medical system of Florence, the capital of Tuscany (the only one operating in Italy during the study period), affected this lower mortality rate.. Retrospective study.. The Florence system consists of 17 mobile ICUs, each of which is staffed by a physician and three paramedics. These units are able to carry out advanced cardiopulmonary resuscitation with equipment transported to the scene of an emergency.. A total of 126 consecutive patients with heroin overdose, assisted by four mobile ICUs from January 1, 1984 through December 31, 1987.. Common therapeutic protocol in the treatment of heroin overdose and of cardiac arrest.. Fifty-two (41.3%) patients were in respiratory arrest, and seven (5.6%) patients were in cardiorespiratory arrest. The prehospital mortality rate was 1.6%, the inhospital mortality rate was 0.8%, and the overall mortality rate was 2.4%. During the period considered, the number of heroin overdose-related interventions increased significantly, as did the number of heroin overdoses complicated by respiratory arrest or by cardiorespiratory arrest, but the mortality rate remained low.. We suggest that an emergency medical system can play an important role in reducing the mortality rate from heroin overdose.

Topics: Adolescent; Adult; Ambulances; Analysis of Variance; Cardiopulmonary Resuscitation; Chi-Square Distribution; Drug Overdose; Emergency Medical Services; Heart Arrest; Heroin; Humans; Italy; Respiratory Insufficiency; Retrospective Studies

Topics: Heart Arrest; Heroin; Humans; Male; Middle Aged; Naloxone; Ventricular Fibrillation

Topics: Adult; Drug Contamination; Heart; Heart Arrest; Heroin; Humans; Male; Morphine Dependence; Quinine

Topics: Adult; Anesthesia, General; Asphyxia; Barbiturates; Brain; Brain Diseases; Female; Forensic Medicine; Globus Pallidus; Heart Arrest; Heroin; Humans; Hypoxia, Brain; Injections, Intravenous; Male; Middle Aged; Morphine Dependence; Necrosis; Peptic Ulcer Perforation; Suicide