Intravenous Lipids: Antidotal Therapy for Drug Overdose and Toxic Effects of Local Anesthetics

Intravenous lipid emulsion is an accepted therapy for the treatment of severe cardiac toxic effects caused by local anesthetics. Lipid emulsion therapy has also been used successfully to treat cardiac arrest and intractable arrhythmias caused by overdoses of antiepileptic drugs, cardiovascular drugs, and psychotropic medications, but experience with intravenous lipids as antidotal therapy in these clinical situations is limited. However, intravenous lipids are relatively safe, widely available, and easy to administer, and many published case reports document their dramatic effectiveness. Patients who have not responded to standard therapies have been quickly revived by administration of intravenous lipids. Use of lipids most likely will increase, and critical care nurses should be familiar with lipid therapy.

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Intravenous Lipid Emulsion for Management of Systemic Toxic Effects of Drugs

AACN Advanced Critical Care ◽

10.4037/aacnacc2016570 ◽

2016 ◽

Vol 27 (4) ◽

pp. 394-404 ◽

Cited By ~ 1

Author(s):

Jaclyn O’Connor ◽

Suprat Saely Wilson

Keyword(s):

Emergency Department ◽

Local Anesthetics ◽

Lipid Emulsion ◽

Rescue Therapy ◽

Hemodynamic Instability ◽

The United States ◽

Emergency Department Visits ◽

Toxic Effects ◽

Intravenous Lipid Emulsion ◽

The Past

The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics. But data continue to emerge on the successful use of ILE to treat overdoses of drugs other than local anesthetics, particularly lipophilic medications. The recommended ILE dose is a 1.5 mL/kg bolus followed by infusion of 15 mL/kg per hour, with repeat dosing permissible for continued hemodynamic instability. Use of ILE should be considered early as a rescue therapy in the settings of lipophilic medication overdoses when cardiovascular compromise or cardiac arrest is present.

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Abstract 379: Nursing Perspectives on Neuro-Prognostication for Post-Cardiac Arrest Patients and Their Integral Role in Supporting Surrogate Decision Makers

Circulation ◽

10.1161/circ.140.suppl_2.379 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Sarah M Perman ◽

Bonnie J Siry ◽

Stacie L Daugherty ◽

Edward Havranek

Keyword(s):

Decision Making ◽

Cardiac Arrest ◽

Critical Care ◽

Critical Care Nurses ◽

Decision Makers ◽

Team Approach ◽

Integral Role ◽

Uncertainty Set ◽

Surrogate Decision Makers ◽

Surrogate Decision

Introduction: Post cardiac arrest patients frequently rely on surrogate decision makers (SDM) for critical decisions during their hospitalization. Our prior research has shown that bedside nurses are key resources for SDMs. Nurses’ understanding of post-arrest guidelines is therefore crucial if post-arrest care is to be concordant with guidelines. Objective: To explore critical care nurses familiarity with neuroprognostic guidelines and learn how they support families with decision making in the ICU. Methods: This inductive qualitative study consists of interviews with critical care nurses at an urban academic hospital. Subjects were identified by reviewing the care team of recent cardiac arrest patients. Nurses were invited by email to participate. Using a standardized interview guide, one on one interviews were conducted, audio recorded, and transcribed. Transcripts were read in entirety and thematically coded by two investigators. Results: Seven critical care nurses participated in this study. The participants were predominately female (6/7), mean age 32.4 years and had worked in critical care nursing from 1 year to 16 years. The nurses interviewed were based in the medical (3), cardiac (2) and neuro (2) ICUs. Major themes identified were: 1) discussion regarding prognosis is a team approach; 2) interpretation of neuroprognostic guidelines by nurses is variable; 3) communicating uncertainty to families and setting expectations is challenging. Excerpts to support these themes are identified in the table. Conclusion: Nurses are critical stakeholders in supporting surrogate decision makers in their decision-making. Ensuring that they are supported in relaying similar messages as the physician team, provided with more information regarding neurologic prognostication and supported in how to communicate uncertainty/set expectations will assist nurses in the integral and unique roll they play at the bedside of the post-cardiac arrest patient.

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Intensive therapy systemic toxicity of local anesthetics (clinical guidelines)

Regional Anesthesia and Acute Pain Management ◽

10.18821/19936508-2016-10-3-197-204 ◽

2016 ◽

Vol 10 (3) ◽

pp. 197-204

Author(s):

Roman E. Lakhin ◽

V. A Koryachkin ◽

D. N Uvarov ◽

G. E Ulrikh ◽

E. M Shifman ◽

...

Keyword(s):

Cardiac Arrest ◽

Local Anesthetics ◽

Lipid Emulsion ◽

Intensive Therapy ◽

Systemic Toxicity ◽

Clinical Protocols ◽

Recommended Dosage ◽

Mechanisms Of Toxicity ◽

Care Protocol ◽

Helsinki Declaration

Development of the systemic toxicity of local anesthetics can quickly lead to severe bradycardia and hypotension, up to cardiac arrest. The presented clinical recommendations designed to optimize medical care and are included in the list of mandatory clinical protocols according to the Helsinki Declaration on Patient Safety in Anaesthesiology. This review summarizes the main mechanisms of toxicity when using local anesthetics. The guidelines set out criteria and signs of systemic toxicity, recommendations for its prevention. The algorithm of action and recommended dosage of drugs. An intensive care protocol systemic toxicity of local anesthetics including the use of lipid emulsion.

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In-hospital first-responder automated external defibrillation: what critical care practitioners need to know

American Journal of Critical Care ◽

10.4037/ajcc1998.7.4.314 ◽

1998 ◽

Vol 7 (4) ◽

pp. 314-319 ◽

Cited By ~ 14

Author(s):

ME Mancini ◽

W Kaye

Keyword(s):

Cardiac Arrest ◽

Critical Care ◽

Basic Life Support ◽

Life Support ◽

Survival Rates ◽

First Responders ◽

Critical Care Nurses ◽

Automated External Defibrillator ◽

Coronary Care ◽

External Defibrillator

Despite the development and widespread implementation of Basic Life Support and Advanced Cardiac Life Support, the percentage of patients who survive in-hospital cardiac arrest has remained stable at approximately 15%. Although survival rates may approach 90% in coronary care units, survival rates plummet outside of these units. The lower survival rates for cardiac arrest that occur outside of the coronary care unit may relate to the time elapsed between the onset of ventricular fibrillation and first defibrillation. The advent of automated external defibrillators has made it possible to decrease the time elapsed before first defibrillation in non-critical care areas of the hospital. First responders need only recognize that the patient is unresponsive, apneic, and pulseless before attaching and activating the automated external defibrillator. Our research shows that, as part of Basic Life Support training, non-critical care nurses can learn to use the device and can retain the knowledge and skill over time. Establishing an in-hospital automated external defibrillator program requires commitment from administration, physicians, and nursing personnel. Critical care practitioners should be aware of this technology and the literature that supports its safety and effectiveness when used by non-critical care first responders. Critical care nurses are in a unique position to effect changes that will decrease the time between the onset of cardiac arrest and first defibrillation.

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Toxic Effects of Disulfiram Therapy. With Two Case Reports

Quarterly Journal of Studies on Alcohol ◽

10.15288/qjsa.1958.19.418 ◽

1958 ◽

Vol 19 (3) ◽

pp. 418-427 ◽

Cited By ~ 5

Author(s):

N. H. Rathod

Keyword(s):

Case Reports ◽

Toxic Effects

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Adverse Events Reporting System as Experienced by Critical-Care Nurses in KwaZulu-Natal, South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/2456 ◽

2018 ◽

Vol 20 (1) ◽

Author(s):

Thusile Mabel Gqaleni ◽

Busisiwe Rosemary Bhengu

Keyword(s):

South Africa ◽

Critical Care ◽

Adverse Events ◽

Patient Care ◽

Family Involvement ◽

Reporting System ◽

Legal Framework ◽

Critical Care Nurses ◽

Kwazulu Natal ◽

Life Threatening

Critically ill patients admitted to critical-care units (CCUs) might have life-threatening or potentially life-threatening problems. Adverse events (AEs) occur frequently in CCUs, resulting in compromised quality of patient care. This study explores the experiences of critical-care nurses (CCNs) in relation to how the reported AEs were analysed and handled in CCUs. The study was conducted in the CCUs of five purposively selected hospitals in KwaZulu-Natal, South Africa. A descriptive qualitative design was used to obtain data through in-depth interviews from a purposive sample of five unit managers working in the CCUs to provide a deeper meaning of their experiences. This study was a part of a bigger study using a mixed-methods approach. The recorded qualitative data were analysed using Tesch’s content analysis. The main categories of information that emerged during the data analysis were (i) the existence of an AE reporting system, (ii) the occurrence of AEs, (iii) the promotion of and barriers to AE reporting, and (iv) the handling of AEs. The findings demonstrated that there were major gaps that affected the maximum utilisation of the reporting system. In addition, even though the system existed in other institutions, it was not utilised at all, hence affecting quality patient care. The following are recommended: (1) a non-punitive and non-confrontational system should be promoted, and (2) an organisational culture should be encouraged where support structures are formed within institutions, which consist of a legal framework, patient and family involvement, effective AE feedback, and education and training of staff.

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