Jamie M. Rosini

Suspected Tricyclic Antidepressant Overdose Successfully Treated With Lipids

In recent years, the use of intravenous lipid emulsion (ILE) for the treatment of overdoses has become increasingly prevalent in the literature. The role of intravenous lipids in medication overdoses—also referred to as “lipid rescue” or “lipid resuscitation therapy”—is still being assessed because the majority of the available literature exists in the form of case reports and animal studies. The use of lipid formulations as an antidote originated from animal studies whereby administration substantially increased the lethal dose of bupivacaine, a lipophilic local anesthetic, needed to cause mortality in rats. Research progressed further until it was found that human patients having systemic cardiovascular toxicities with local anesthetics were able to be successfully treated with intravenous lipid administration as well. This ultimately culminated in the emergence of case reports using ILE therapy in the treatment of toxidromes associated with a number of lipophilic pharmacologic agents including β-adrenergic antagonists, calcium channel blockers, antipsychotics, antiepileptics, and tricyclic antidepressants (TCAs).

Advanced Cardiac Life Support: What's New, What's Old?

Approximately 300,000 out-of-hospital cardiac arrests occur in the United States each year. The American Heart Association (AHA) supports implementation of the “chain of survival” to rescue people who experience cardiac arrest in the community. The “chain of survival” consists of early recognition and emergency activation (phone 9-1-1), CPR, defibrillation, and advanced care. Advanced Cardiac Life Support (ACLS) encompasses elements designed to increase survival in patients who experience sudden cardiac death. ACLS provides recommendations to trained providers regarding optimizing circulation, airway management, cardiac rhythm management via defibrillation and/or administration of medications, and stabilization of the patient’s condition.

Dantrolene for Treatment of Suspected Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening neurologic disorder caused by neuroleptic medications (ie, antipsychotics). Although there is no confirmatory laboratory test, NMS has a distinct clinical presentation that includes changes in mental status, muscle rigidity, hyperthermia, and autonomic nervous system manifestations such as tachycardia, high blood pressure, or increased respiration rate. NMS has an incidence of roughly 0.2% and is challenging to diagnose, with mortality rates estimated at 5.6%. Faster recognition and diagnosis have likely been the cause of decreased mortality rates over the past decades; however, morbidity is still a significant factor in a patient’s recovery, owing to rhabdomyolysis and organ failure. We report a case of suspected NMS in a patient on multiple neuroleptic medications, successfully treated with dantrolene.

Methicillin-Resistant Staphylococcus Aureus: New Treatment Guidelines for an Old Bug

M ethicillin-resistant Staphylococcus aureus (MRSA) is a common cause of a variety of infections ranging from skin and soft-tissue infections (SSTIs) to more serious infections such as meningitis, endocarditis, and pneumonia. Previously recognized solely as a nosocomial microorganism, MRSA has emerged in community settings (eg, athletic centers, prisons, and military sites) and health care–associated environments (eg, long-term care facilities and dialysis centers). In February 2011 the Infectious Diseases Society of America published its first evidence-based guidelines for the management of MRSA infections. Several antibiotics are available to treat this resistant pathogen (Table 1).

Dexmedetomidine for Treatment of Refractory Heroin Withdrawal

pioid abuse is a significant public health epidemic that is affecting health care institutions across the initiated to mitigate her symptoms. OUnited States. The popularity of heroin use continues to rise with its ease of access and lower cost compared with prescription opioids. The Centers for Disease Control and Prevention reported 10,500 deaths due to heroin overdose in 2014. Whereas overdose or toxicity can be life threatening, heroin withdrawal is uncomfortable but rarely fatal. Withdrawal management consists primarily of the provision of supportive care. We present the case of a patient who, during withdrawal from heroin, remained severely symptomatic despite use of numerous therapeutic agents.