Cyclic Antidepressant Poisoning: A Review and Case Report

1993 ◽  
Vol 6 (2) ◽  
pp. 89-102 ◽  
Author(s):  
Henry Cohen ◽  
Robert S. Hoffman ◽  
Mary Ann Howland
Keyword(s):  
Supportive Care ◽  
Tricyclic Antidepressants ◽  
Vital Signs ◽  
The United States ◽  
Qrs Complex ◽  
The Past ◽  
Life Threatening ◽  
Gastrointestinal Decontamination ◽  
Cns Depression ◽  
Intravenous Sodium

Although newer cyclic antidepressants have been introduced over the past several years, the tricyclic antidepressants (TCAs) continue to be the leading cause of morbidity from drug overdose in the United States. Overdose features depend on the particular cyclic antidepressant ingested and its pharmacological properties, and can include CNS depression, cardiac arrhythmias, hypotension, seizures, and anticholinergic symptomatology. Life-threatening symptomatology almost always begins within 2 hours, and certainly within 6 hours, after arrival to the emergency department. Plasma TCA levels are unreliable predictors of TCA toxicity and are not recommended. An ECG with a prolonged QRS complex more than 100 msec seems to be the best indicator of serious sequelae with TCAs. Management consists of stabilization of vital signs, gastrointestinal decontamination, intravenous sodium bicarbonate, and supportive care. Agents once thought to be useful for the treatment of cardiac dysrhythmias and seizures such as phenytoin and physostigmine should be avoided. The future of TCA antibody fragments in the treatment of TCA overdose seems promising. Newer and, to some degree, safer antidepressants in overdose have recently been introduced, and they include fluoxetine, trazodone, and sertraline. Amoxapine, bupropion, and maprotiline seem to be as toxic as the TCAs. A significant interaction between cyclic antidepressants and monoamine-oxidase inhibitors exists. Management includes supportive care and basic poison management. Prevention of poisoning seems to be the most logical and effective method of maintaining patient safety. TCAs should be avoided in children younger than 6 years old. All adults with suicidal ideations should receive no more than a 1-week supply (about 1 g) of drug. Finally consideration should be given to using one of the newer, safer antidepressants in all patients with suicidal ideations.

Antidepressant Poisoning and Treatment: A Review and Case Illustration

1997 ◽  
Vol 10 (4) ◽  
pp. 249-270 ◽  
Author(s):  
Henry Cohen ◽  
Robert S. Hoffman ◽  
Mary Ann Howland
Keyword(s):  
Supportive Care ◽  
Tricyclic Antidepressants ◽  
Vital Signs ◽  
The United States ◽  
The Past ◽  
Cardiac Dysrhythmias ◽  
Life Threatening ◽  
Gastrointestinal Decontamination ◽  
Cns Depression ◽  
Intravenous Sodium

Although newer antidepressants have been introduced over the past several years, the tricyclic antidepressants (TCAs) continue to be a leading cause of morbidity from drug overdose in the United States. Overdose features depend on the particular cyclic antidepressant ingested and its pharmacological properties, and can include CNS depression, cardiac dysrhythmias, hypotension, seizures, and anticholinergic symptoms. Life-threatening events almost always begin within two hours, and certainly within six hours, after arrival to the emergency department. Plasma TCA levels are unreliable predictors of TCA toxicity and are therefore not recommended. An ECG with a prolonged QRS complex more than 100 msec seems to be the best indicator of serious sequelae with TCA overdose. Management consists of stabilization of vital signs, gastrointestinal decontamination, intravenous sodium bicarbonate, and supportive care. Agents once thought to be useful for the treatment of cardiac dysrhythmias and seizures such as phenytoin and physostigmine should be avoided. The future of TCA antibody fragments in the treatment of TCA overdose seems promising. Amoxapine, bupropion, and maprotiline seems to be as toxic as the TCAs. Overdose data is limited for venlafaxine, and mirtazapine, and preclude firm conclusions. A significant interaction between cyclic antidepressants and monoamine-oxidase inhibitors exists. Management includes supportive care and basic poison management. Prevention of poisoning seems to be the most logical and effective method of maintaining patient safety. TCAs should be avoided in children younger than 6 years old. All adults with suicidal ideations should receive no more than a one-week supply (less than 1 g) of drug. Newer and, to some degree, safer antidepressants in overdose have recently been introduced, and they include fluoxetine, sertraline, paroxetine, trazodone, and nefazodone. Finally, consideration should be given to using one of these newer, safer antidepressants in all patients with suicidal ideations.

scholarly journals Shock index as a predictor of vasopressor use in patients with sepsis

2019 ◽  
Vol 6 (5) ◽  
pp. 1488
Author(s):  
Prashanth V. N. ◽  
Sneha .
Keyword(s):  
Organ Failure ◽  
Vital Signs ◽  
The United States ◽  
Shock Index ◽  
Vasopressor Therapy ◽  
Failure Assessment ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
A Prospective Study ◽  
Vasopressor Use

Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are major healthcare problems affecting millions of people around the world each year and killing as many as one in four. The documented incidence of sepsis worldwide is 1.8 million each year with mortality rate of almost 30%. Sepsis is the 10th leading cause of death in the United States. Shock index (SI) is defined as “Heart rate divided by Systolic blood pressure (HR/SBP)”. Normal range is 0.5 to 0.7 in healthy adults.Methods: A Prospective study was conducted between August 2018 to March 2019 comprising of 100 consecutive patients presenting to emergency department and ICU with sepsis. Subjects were identified by having evidence of infection presenting with cardiovascular collapse or organ failure with help of q-SOFA(quick- sepsis related  organ failure assessment )  and SOFA scores (sequential organ failure assessment score).Cases with clear alternative diagnosis were excluded. Vital signs were recorded, and Shock index was calculated. Primary outcome, which was use of Vasopressor therapy was analysed. Results : A Total of 100 cases were studied, of which 70 patients were males and 30 females with mean age of 48.5 ±16.2 yrs. Most of the cases were between 35 to 60 years. Patients were classified into 3 categories based on shock index:1. <0.8 (normal, n=16) 2. 0.8 to <1.2 (n=29)  3. >1.2 (n=55).  The use of vasopressor therapy within first 24 hours for each group was 18%, 34%, and 78%. This difference was statistically significant (p=<0.05).Conclusion : In patients with sepsis an elevated shock index was indicator of early vasopressor therapy in the first 24hours. It is a simple bedside tool to identify septic patients in need for early vasopressor therapy thereby preventing further clinical deterioration.

Inflight use of extracorporeal membrane oxygenation for severe neonatal respiratory failure

Perfusion ◽  
1986 ◽  
Vol 1 (4) ◽  
pp. 281-287 ◽  
Author(s):  
J. Devn Cornish ◽  
Dale R Gerstmann ◽  
Martin J Begnaud ◽  
Donald M Null ◽  
Neil B Ackerman
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Air Transport ◽  
Referral Centre ◽  
Therapeutic Measure ◽  
The Past ◽  
Membrane Oxygenation ◽  
Life Threatening ◽  
Ecmo Treatment

Extracorporeal membrane oxygenation (ECMO) is a heart-lung bypass technique which has been used over the past ten years to support some 300 neonates with life-threatening respiratory failure. It is estimated that, within the constraints of currently accepted treatment criteria, there are between 2,000 and 3,000 neonates born each year within the United States who require this extreme therapeutic measure. Unfortunately, since there are still relatively few medical centres in the country offering this type of support, it is frequently necessary to transport candidate neonates from the hospital of birth to a referral centre. This is generally a tenuous procedure since neonates who are sufficiently ill to require ECMO treatment are commonly poor transport risks. We report the first successful use of an ECMO system designed to be transported to the referring hospital, assembled, and used to support an infant on bypass for a controlled air transport back to the receiving medical centre. The potential for decreasing the morbidity and mortality of selected infants requiring ECMO support by the addition of this capability is discussed.

International Research and Variation in Views of Ethnicity

2012 ◽  
Vol 2 (2) ◽  
pp. 66-72
Author(s):  
Ella Inglebret ◽  
Amy Skinder-Meredith ◽  
Shana Bailey ◽  
Carla Jones ◽  
Ashley France
Keyword(s):  
United States ◽  
Classification System ◽  
International Research ◽  
The United States ◽  
Research Articles ◽  
Journal Articles ◽  
Research Participants ◽  
The Past ◽  
International Scale ◽  
Publication Patterns

The authors in this article first identify the extent to which research articles published in three American Speech-Language-Hearing Association (ASHA) journals included participants, age birth to 18 years, from international backgrounds (i.e., residence outside of the United States), and go on to describe associated publication patterns over the past 12 years. These patterns then provide a context for examining variation in the conceptualization of ethnicity on an international scale. Further, the authors examine terminology and categories used by 11 countries where research participants resided. Each country uses a unique classification system. Thus, it can be expected that descriptions of the ethnic characteristics of international participants involved in research published in ASHA journal articles will widely vary.

Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex

Crisis ◽  
2020 ◽  
pp. 1-5
Author(s):  
Shannon Lange ◽  
Courtney Bagge ◽  
Charlotte Probst ◽  
Jürgen Rehm
Keyword(s):  
United States ◽  
Suicidal Ideation ◽  
Random Effects ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
The United States ◽  
Individual Level ◽  
The Past ◽  
Meta Analyses ◽  
Age Category

Abstract. Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008–2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18–25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

EDITORIAL: Migration and competitiveness: Japan and the United States

2013 ◽  
Vol 10 (2) ◽  
pp. 115-124
Author(s):  
Philip L. Martin
Keyword(s):  
United States ◽  
The United States ◽  
Variable Cost ◽  
Fixed Cost ◽  
Special Issue ◽  
Science And Engineering ◽  
The Past ◽  
Past Half Century ◽  
Key Sectors ◽  
Past Half

Japan and the United States, the world’s largest economies for most of the past half century, have very different immigration policies. Japan is the G7 economy most closed to immigrants, while the United States is the large economy most open to immigrants. Both Japan and the United States are debating how immigrants are and can con-tribute to the competitiveness of their economies in the 21st centuries. The papers in this special issue review the employment of and impacts of immigrants in some of the key sectors of the Japanese and US economies, including agriculture, health care, science and engineering, and construction and manufacturing. For example, in Japanese agriculture migrant trainees are a fixed cost to farmers during the three years they are in Japan, while US farmers who hire mostly unauthorized migrants hire and lay off workers as needed, making labour a variable cost.

The Evolution of Lead Extraction

2009 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Melanie Maytin ◽  
Laurence M Epstein ◽  
◽  
Keyword(s):  
Natural Selection ◽  
Lead Extraction ◽  
Significant Morbidity ◽  
Extraction Techniques ◽  
Extraction Technology ◽  
Device Management ◽  
Future Developments ◽  
The Past ◽  
New Methods ◽  
Life Threatening

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.

Democratic Legitimacy

2011 ◽  
Author(s):  
Pierre Rosanvallon
Keyword(s):  
United States ◽  
The United States ◽  
Democratic Legitimacy ◽  
Political Leaders ◽  
Constitutional Courts ◽  
International Debate ◽  
The Past ◽  
Democratic Authority ◽  
Original Contribution ◽  
Western Democracies

It's a commonplace occurrence that citizens in Western democracies are disaffected with their political leaders and traditional democratic institutions. But this book argues that this crisis of confidence is partly a crisis of understanding. The book makes the case that the sources of democratic legitimacy have shifted and multiplied over the past thirty years and that we need to comprehend and make better use of these new sources of legitimacy in order to strengthen our political self-belief and commitment to democracy. Drawing on examples from France and the United States, the book notes that there has been a major expansion of independent commissions, NGOs, regulatory authorities, and watchdogs in recent decades. At the same time, constitutional courts have become more willing and able to challenge legislatures. These institutional developments, which serve the democratic values of impartiality and reflexivity, have been accompanied by a new attentiveness to what the book calls the value of proximity, as governing structures have sought to find new spaces for minorities, the particular, and the local. To improve our democracies, we need to use these new sources of legitimacy more effectively and we need to incorporate them into our accounts of democratic government. This book is an original contribution to the vigorous international debate about democratic authority and legitimacy.

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