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Adrenaline in shock

Sandeep Tak, Manoj Lakhotia, Alok Gupta, Amit Sagar, Gopal Bohra, Rajesh Bajari
A 55-year-old male presented with history of nausea, vomiting, palpitation paresthesis and profuse sweating in emergency department 2h after ingestion of "Bachnaag" (Aconite) root. Examination revealed shock with irregular pulses. Initial ECG showed frequent multifocal ventricular ectopics (VE), which later turned to short runs of ventricular tachycardia (VT). Immediate gastric lavage was done and activated charcoal given. Patient was treated with fluid resuscitation without any improvement in blood pressure...
September 2016: Indian Heart Journal
Antonio Mirijello, Gaetano Pepe, Patrizio Zampiello, Giovanni Marco Criconia, Angela Mendola, Antonio Manfrini
BACKGROUND: Approximately 1% of emergency department (ED) visits are due to anaphylaxis. Symptoms can include skin rash, facial and laryngeal edema, dyspnea, vomiting, hypotension, and shock. A transient loss of consciousness can also be a manifestation of anaphylaxis. A variety of electrocardiographic changes due to anaphylaxis have been described for Kounis syndrome, also known as allergic angina. CASE REPORT: Here we describe the case of a male patient presenting at an ED with syncope, anaphylactic shock, and ST-segment elevation on electrocardiogram (ECG)...
October 2016: Journal of Emergency Medicine
Geoffrey K Isbister, Karyn Ang, Kieron Gorman, Joyce Cooper, Ahmed Mostafa, Michael S Roberts
OBJECTIVE: Acute beta-blocker overdose can cause severe cardiac dysfunction. Chronic toxicity is rare but potentially severe. We report therapeutic dosing of metoprolol resulting in unusual pharmacokinetics and toxicity, given high-dose insulin therapy for treatment. CASE DETAILS: A 90-year-old female presented with hypotension, tachycardia and severe cardiac dysfunction after commencing a rapidly increasing metoprolol dose of 250 mg split daily. She was admitted to intensive care and given high-dose insulin therapy (10 U/kg/h), noradrenaline, adrenaline and dobutamine for severe cardiac dysfunction (cardiac index, 0...
November 2016: Clinical Toxicology
Tuukka Tarvasmäki, Johan Lassus, Marjut Varpula, Alessandro Sionis, Reijo Sund, Lars Køber, Jindrich Spinar, John Parissis, Marek Banaszewski, Jose Silva Cardoso, Valentina Carubelli, Salvatore Di Somma, Alexandre Mebazaa, Veli-Pekka Harjola
BACKGROUND: Vasopressors and inotropes remain a cornerstone in stabilization of the severely impaired hemodynamics and cardiac output in cardiogenic shock (CS). The aim of this study was to analyze current real-life use of these medications, and their impact on outcome and on changes in cardiac and renal biomarkers over time in CS. METHODS: The multinational CardShock study prospectively enrolled 219 patients with CS. The use of vasopressors and inotropes was analyzed in relation to the primary outcome, i...
2016: Critical Care: the Official Journal of the Critical Care Forum
Renu R Raj, Sathya Subramani
Phenylephrine (PE) causes vasoconstriction through alpha adrenergic receptors. PE-induced vasodilatation has also been reported earlier in pre-constricted vessels. Here we demonstrate in spiral strips of goat arteries that addition of PE can decrease tone even from base-line levels (i.e. not pre-constricted) and show that this process requires nitric oxide (NO) and alpha adrenergic stimulation, but is cGMP-independent. Under control conditions, PE caused vasoconstriction, but under conditions where NO levels are higher, as with L-Arginine or sodium nitroprusside, PE decreased vessel tension...
2016: PloS One
Tatsuo Horiuchi, Tomonori Takazawa, Shigeru Saito
We report here a case of rocuronium-induced anaphylactic shock in a 41-year-old woman. She was scheduled for partial hepatectomy due to liver metastasis of a pheochromocytoma. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was difficult, and her blood pressure fell to around 40 mmHg just after induction. Subsequently, her trachea was intubated and adrenaline was injected. However, due to the subsequent persistence of severe hypotension and hypoxia, cardiopulmonary resuscitation was necessary...
March 2016: Masui. the Japanese Journal of Anesthesiology
Shuhei Ota, Takuya Yazawa, Kentaro Tojo, Yasuko Baba, Munehito Uchiyama, Takahisa Goto, Kiyoyasu Kurahashi
BACKGROUND: We often administer adrenaline to improve hypotension of patients undergoing systemic inflammation that is not treated with volume resuscitation. The effects of adrenaline on injured lungs during shock status have not been elucidated. We previously demonstrated that hepatic ischemia-reperfusion followed by high-tidal-volume ventilation-induced systemic inflammation, hypotension, and lung injury in rats. Using this animal model, we investigated the effects of adrenaline on lung injury and hemodynamics...
2016: Journal of Intensive Care
Mert İlker Hayıroğlu, Özlem Yıldırımtürk, Mehmet Bozbay, Mehmet Eren, Seçkin Pehlivanoğlu
Hypertensive emergency usually appears in older patients with previous recurrent episodes, and is among the most frequent admissions to emergency departments. A 29-year-old woman was referred to our clinic with the diagnosis of hypertensive emergency. The patient complained of severe headache, dyspnea, palpitation, diaphoresis, and confusion due to hypertensive encephalopathy. Her blood pressure was 250/150 mmHg on admission. At the referral hospital, the patient had undergone cranial CT because of her confused state and this excluded acute cerebral hemorrhage...
December 2015: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Shilpa Reynal D'sa, John Victor Peter, Binila Chacko, Kishore Pichamuthu, Sowmya Sathyendra
BACKGROUND: Cardiomyopathy, cardiogenic shock or acute pulmonary oedema are well recognised complications of scorpion sting envenomation occurring in about 1-3% of patients. Current treatment recommendations include afterload reduction using prazosin and improving cardiac contractility with inotropes like dobutamine. We report the use of intra-aortic balloon pump (IABP) as rescue therapy in a patient with refractory cardiogenic shock due to Mesobuthus tamulus (Indian red scorpion) envenomation...
2016: Clinical Toxicology
Kristina Krmpotic, Hilary Writer
INTRODUCTION: Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children per year in resource-rich countries, with two-thirds of arrests occurring in children under 18 months of age. Approximately 45% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for non-submersion out-of-hospital cardiorespiratory arrest in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...
2015: Clinical Evidence
Alper Ozcan, Emre Baratalı, Ozge Meral, Ayşe Betul Ergul, Hümeyra Aslaner, Ramazan Coskun, Yasemin Altuner Torun
Extravasation of vasopressors can have serious complications varying from simple local reactions to skin necrosis and compartment syndrome. Here, we presented bullous dermatitis and skin necrosis which developed due to extravasation of adrenalin infusion in a Hodgkin lymphoma patient with septic shock who was admitted due febrile neutropenia.
October 2015: Eurasian Journal of Medicine
Khalil Pourkhalili, Euikyung Kim, Navid Reza Mashayekhy, Mostafa Kamyab, Seyed Mehdi Hoseiny, Reihane Evazy, Abbas Zare Mirakabadi, Ramin Seyedian
BACKGROUND: Envenomation by Hemiscorpius lepturus is not painful and the clinical manifestations include bloody urine due to hemoglobinuria or hematuria, dermonecrotic reactions, cardiac arrhythmia and in minority of cases acute renal failure which may lead to death following disseminated intravascular coagulation in infants. Cardiac effects of envenomation by H. lepturus venom including inotropic, chronotropic and arrhythmogenic properties are not studied as now in rat hearts with Langendorff apparatus...
December 2015: Journal of Arthropod-borne Diseases
Hiroyuki Koami, Yuichiro Sakamoto, Takashi Furukawa, Hisashi Imahase, Takashi Iwamura, Satoshi Inoue
We present a case of hyperfibrinolysis induced by oxaliplatin-derived anaphylactic shock, which was diagnosed with rotational thromboelastometry (ROTEM). A 57-year-old male patient underwent a second course of oxaliplatin (126 mg/m/course)-based chemotherapy for stage IV metastatic rectal cancer. Two minutes after the infusion of oxaliplatin, the patient lost consciousness and developed generalized urticarial lesions, followed by hemodynamic instability and respiratory insufficiency. He was diagnosed anaphylactic shock and transported to emergency department (ED) after intramuscular injection of 0...
June 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Tomoko Nakagawa, Kazunori Sakai, Naofumi Hayashi, Arisa Sato, Kemal Sasaki, Teruaki Matsui, Shiro Sugiura, Naoyuki Kando, Komei Ito
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is often reported in adults for whom the specific IgE to ω-5 gliadin can be a useful diagnostic test. However, few cases of WDEIA in children have been reported. We herein report six cases (aged 7-16 years) of children with WDEIA, who had no clinical history of immediate-type wheat allergy but who were diagnosed by a wheat ingestion + exercise provocation test. The specific IgE to wheat ranged <0.35-3.49 (median 1.64) UA/ml. Skin prick tests using wheat extract were performed on 3 patients who showed either a negative or low specific IgE titer to wheat, and all of them resulted in negative findings...
August 2015: Arerugī, [Allergy]
Diab Ghanim, Zvi Adler, Dahud Qarawani, Fabio Kusniec, Offer Amir, Shemy Carasso
INTRODUCTION: Stress-induced cardiomyopathy (Takotsubo) after bee stings in patients who have received catecholamines is rare. Endogenous as well as exogenous administration of catecholamines is thought to trigger stress-induced cardiomyopathy. CASE PRESENTATION: A 37-year-old healthy white woman was stung by an unknown Hymenoptera that resulted in an anaphylactic reaction. Intravenous adrenaline (0.9 mg) was administered at a nearby clinic; she was transferred to our emergency room...
2015: Journal of Medical Case Reports
Chizuru Yamashita, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Osamu Nishida
Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) therapy is widely used for the treatment of severe sepsis and septic shock, and is generally performed for 2 h. Although previous studies demonstrated the efficacy of PMX-DHP therapy, it currently remains unclear whether its optimal duration is 2 h. This retrospective study analyzed 37 patients with septic shock who showed a poor clinical response to 2 h of PMX-DHP, and underwent a longer duration of this therapy. The mean duration of PMX-DHP therapy was 15...
August 2015: Therapeutic Apheresis and Dialysis
K A Scherf, K Brockow, T Biedermann, P Koehler, H Wieser
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare, but potentially severe food allergy exclusively occurring when wheat ingestion is accompanied by augmenting cofactors. It is clinically characterized by anaphylactic reactions ranging from urticaria and angioedema to dyspnoea, hypotension, collapse, and shock. WDEIA usually develops after ingestion of wheat products followed by physical exercise. Other cofactors are acetylsalicylic acid and other non-steroidal anti-inflammatory drugs, alcohol, and infections...
January 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Victor F Semenkov, Anatoli I Michalski, Alexander M Sapozhnikov
Different environmental factors (i.e., toxins, heavy metals, ultraviolet (UV) rays, and X-radiation) cause damage to DNA, cell membranes and other organelles and induce oxidative stress, which results in the excessive production of reactive oxygen species (ROS) by phagocytes. All types of cell stress are accompanied by the activation of anti-stress genes that can suppress ROS synthesis. We hypothesized that different environmental factors would affect organisms through the activation of anti-stress genes by autologous serum (AS) proteins, followed by the synthesis of molecules that increase cell resistance to oxidative stress...
2015: Frontiers in Genetics
L W J Sampson, N van der Schyff, C Cupido
A 21-year-old woman with no past medical history of note was found unconscious together with five of her family members after prolonged exposure to liquefied petroleum gas. She was admitted to the intensive care unit at Victoria Hospital, Wynberg, Cape Town, South Africa, following resuscitation for pulseless electrical activity. On examination the following was found: coma without focal neurology; shock requiring fluid resuscitation and adrenaline; probable pneumonitis or aspiration pneumonia; acute rhabdomyolysis with severe metabolic acidosis; and raised serum K+...
February 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
George Karlis, Nicoletta Iacovidou, Pavlos Lelovas, Panagiota Niforopoulou, Apostolos Papalois, Ioanna Siafaka, Spyros Mentzelopoulos, Theodoros Xanthos
PURPOSE: The purpose of the experiment was to compare the effects of nifekalant and amiodarone on the return of spontaneous circulation (ROSC), survival, as well as on the hemodynamic parameters in a swine model of prolonged ventricular fibrillation (VF). METHODS: After 8 min of untreated VF, bolus doses of epinephrine (adrenaline) and either nifekalant, or amiodarone, or saline (n = 10 per group), were administered after randomization. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration and defibrillation was attempted 2 min later...
2015: Cardiovascular Drugs and Therapy
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