Patterns of use of an emergency department-based observation unit.

Emergency department (ED)-based observation units are becoming increasingly used for the assessment and treatment of patients who may not require inpatient management or monitoring. This is a retrospective study of 5,714 patients seen in an ED observation unit from October 16, 1996 through July 12, 2000. Of the 5,714 patients seen in the observation unit, 4,191 were discharged and 1,314 were admitted.

Seizures, ventricular tachycardia, and rhabdomyolysis as a result of ingestion of venlafaxine and lamotrigine.

Few cases of overdoses have been described involving venlafaxine, lamotrigine, or a combination of the two agents. We describe a combined venlafaxine and lamotrigine ingestion in a patient presenting with a seizure, ventricular tachycardia, and rhabdomyolysis. We conclude that patients with overdoses that involve venlafaxine can exhibit severe cardiac effects in addition to seizures, especially if venlafaxine is combined with other agents.

Tricyclic antidepressants in red cells and plasma: correlation with impaired intraventricular conduction in acute overdose.

Objective: Tricyclic antidepressant levels in red blood cells and plasma in acute overdose and their association with cardiotoxicity were studied.

Methods: This was a prospective study in 15 patients with acute tricyclic antidepressant overdose. Tricyclic antidepressant parent compounds and metabolites were measured in red blood cells and plasma, and tricyclic antidepressant levels were correlated with ECG indexes of toxicity.

Hyperventilation. Benign symptom or harbinger of catastrophe?

Hyperventilation is a common feature of many acute clinical conditions that can be benign or potentially catastrophic. The symptoms accompanying hyperventilation are diverse and non-specific, reflecting a physiologic state of hypocapnia secondary to alveolar overventilation. Results of arterial blood gas analysis confirm hypocapnia and may lead to identification of the clinical cause, with pH or PaO2 measurements indicating acid-base abnormalities or hypoxemia.

Cardiopulmonary resuscitation. A current perspective.

Cardiopulmonary resuscitation is effective if established early and coupled with specific therapeutic interventions. Most cardiopulmonary arrest is due to ventricular fibrillation and early defibrillation offers the highest probability of success. External cardiac compression alone is inadequate to provide adequate perfusion to vital organs and, therefore, cannot sustain life unless coupled with advanced therapeutic interventions.

Reversal of tricyclic-antidepressant-induced cardiac conduction abnormalities by phenytoin.

Ten patients with cardiac conduction defects due to severe tricyclic antidepressant poisoning were successfully treated with intravenous phenytoin. Eight patients had combined first degree AV block and intraventricular conduction delay; one patient had first degree AV block alone; and one patient had intraventricular conduction delay alone. Phenytoin was injected at a rate of 50 mg/min in amounts not exceeding 500 mg (approximately 5 mg/kg to 7 mg/kg).