phenylephrine-hydrochloride and Poisoning

In the patient obtunded by drug intoxication, the optimal method of airway protection prior to gastric emptying is not clear. We report a prospective randomized trial of two methods of intubation in this patient population. Fifty-two overdose patients with Glascow Coma Scale scores of 12 or less were intubated either orotracheally after succinylcholine administration or nasotracheally. Success rate, time to intubate, difficulty, and complications of intubation were compared for the two groups. We found a success rate of 100% (23 of 23) for succinylcholine assisted intubation (SAI) versus 65% (19 of 29) success with blind nasotracheal intubation (BNI). Mean time to intubate was 64 seconds and 276 seconds in the SAI and BNI groups, respectively. Eighty-six percent (19 of 22) of patients were intubated successfully in less than 120 seconds in the SAI group versus 37% (10 of 27) in the BNI group (P less than .005). In the SAI group, the mean number of attempts was 1.3 per patient, (range, one to three) with 96% (22 of 23) having two or fewer attempts. No complications were identified. In the BNI group, the mean number of attempts was 3.7 per patient, (range, one to 13) with 45% (13 of 29) having two or fewer attempts (P less than .005). Sixty-nine percent of the BNI group experienced epistaxis, 17% had vomiting, and 10% aspirated. We conclude that SAI is a safe and effective method of airway protection in the obtunded poisoned patient. Complications and difficulty in intubation were significantly less with SAI than with blind nasotracheal intubation.

Topics: Adult; Humans; Intubation, Intratracheal; Mouth; Nose; Pneumonia, Aspiration; Poisoning; Prospective Studies; Random Allocation; Succinylcholine

A 75-year-old woman with a previous repair of a cribiform plate fracture was nasotracheally intubated following a suicide attempt. Twenty-one days later she was readmitted to the hospital with a massive pneumocephalus, followed by a terminal intracranial hemorrhage. Nasotracheal intubation as a contributing factor in the development of pneumocephalus is previously unreported.

Topics: Aged; Cerebral Hemorrhage; Drug Overdose; Female; Humans; Intubation, Intratracheal; Nose; Pneumocephalus; Poisoning; Suicide, Attempted; Temazepam; Tomography, X-Ray Computed

Topics: Aerosols; Animals; Animals, Laboratory; Nose; Poisoning

Topics: Corrosion; Heavy Metal Poisoning; Humans; Metals, Heavy; Nasal Cavity; Nose; Paranasal Sinuses; Poisoning; Regeneration; Sulfates; Zinc; Zinc Sulfate

Topics: Camphor; Eating; Humans; Nose; Poisoning

Topics: Ammonia; Humans; Larynx; Nose; Poisoning; Respiratory Tract Diseases; Trachea