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Asphyxia
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
Asphyxia is defined as the interference with the uptake or utilization of oxygen with a subsequent reduction in the oxygen level within the blood, cells, tissues, and organs.1 Loss of consciousness occurs within seconds and may take as long as 13–18 seconds to occur, according to one report of four filmed hangings (two suicides and two autoerotic accidents).2 Respiratory arrest followed by cardiac arrest ensues after several minutes. In fact, the heart will continue to beat, and there will be a pulse for as long as ten minutes after respiratory arrest.1 Death due to asphyxia occurs in one of several ways: Obstruction of the external airway (nose and mouth)Obstruction of the internal airway (oral cavity, larynx, trachea, bronchi, lungs)Compression/occlusion of the blood vessels of the neck (carotid arteries, jugular veins)Severe flexion of the neck or compression of the chest or abdomenImpairment of O2 utilization by the body’s cellsDisplacement of O2 from the ambient environment
Disorders of vitamin B6 metabolism
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
With more patients known, it became obvious that the clinical presentation of PNPO deficiency and antiquitin deficiency were overlapping if not identical [4, 7, 33, 34]. Patients suffering from PNPO deficiency tend to present with a more severe and complex symptomatology. Clinical responsiveness to pyridoxine does not exclude PNPO deficiency. Thus, patients with pyridoxine dependency negative for antiquitin deficiency should be tested for PNPO deficiency and if negative for mutations in PROSC. PNP administered by nasogastric tube is mostly dramatically effective in stopping the seizures and improving the EEG. First administration may result in respiratory arrest in responders, and thus treatment should be performed with support of respiratory management [4]. Patients with PNPO deficiency usually require more frequent and equally spaced administration of PNP than patients with antiquitin deficiency, e.g. every three to four hours. This can be guided well by EEG monitoring which normal at first, shows generalized rhythmic fast activity. After PLP symptoms resolve within minutes, and the EEG normalizes. Cranial MR is mostly normal early in the disease course or shows unspecific findings of encephalopathy (Figure 100.4). Later, MRI scans may reveal severe diffuse cerebral atrophy in untreated or only partially treated patients.
Acute airway conditions
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Panagiotis Asimakopoulos, Mary-Louise Montague
Early signs of respiratory failure include tachypnoea progressing to bradypnoea and tachycardia. Further clinical deterioration will result in bradycardia and increased work of breathing, which will then progress to fatigue and decreased work of breathing. Cyanosis and altered level of consciousness are ominous signs of respiratory arrest.
Characteristics and circumstances of volatile solvent misuse-related death in Australia, 2000–2021
Published in Clinical Toxicology, 2023
Shane Darke, Emma Zahra, Johan Duflou, Amy Peacock, Michael Farrell, Julia Lappin
The misuse of volatile substances is associated with a wide range of harms. Neuropsychiatric harms across the range of volatile solvents include cerebral and cerebellar white matter atrophy, cerebral oedema, in addition to intense agitation and an acute psychosis that may increase the acute risk of self-harm or traumatic injury [2,5,6]. Unlike other volatile solvents, nitrous oxide is causally associated with myeloneuropathy and spinal cord degeneration due to interference in the metabolism of vitamin B12 [2,4,5,7,8]. Cardiovascular harms include cardiac dysrhythmias and cardiomyopathy [9–12]. Acute respiratory arrest has been documented [13,14], as well as kidney disease and kidney failure [2,15]. Hydrocarbons have also been associated with “sudden sniffing death”, a syndrome characterised by sudden collapse shortly after inhalation, due to cardiac and/or respiratory arrest [2,16,17]. Methaemoglobinaemia has rarely been implicated in deaths where amyl nitrite and similar volatiles have been consumed [18].
Exploring the role of botulinum toxin in critical care
Published in Expert Review of Neurotherapeutics, 2021
Muhammad Ubaid Hafeez, Michael Moore, Komal Hafeez, Joseph Jankovic
The systemic AEs can include a flu-like syndrome, manifesting as severe malaise and myalgias [85]. On the other hand, despite a foreign protein injection, true allergic reactions are extremely rare [86]. Isolated occurrences of myocardial infarction (MI), pulmonary embolism (PE) and stroke have been reported suggesting a possible prothrombotic or embolic mechanism [87]. Seizures have been reported however, majority of such patients had a history or pre-morbid condition predisposing to seizures [87]. From 1989 to 2005, 28 possible BoNT-related deaths were reported to FDA. The causes were attributed to respiratory arrest, MI, stroke, PE, pneumonia, and unknown etiologies [87]. It is hard to establish if these events represent a temporal coincidence or a true causal relationship due to low incidence and paucity of supporting evidence from larger studies. A closer monitoring for these AEs in future clinical trials can provide a better insight into true incidence of such events [88,89].
National Systematic Legal Review of State Policies on Emergency Medical Services Licensure Levels' Authority to Administer Opioid Antagonists
Published in Prehospital Emergency Care, 2018
Jeremiah M. Kinsman, Kathy Robinson
In the United States, there were 52,404 drug overdose deaths in 2015, of which 33,091 (63.1%) were known to have involved opioids (1). Opioids cause central nervous system depression which can lead to decreased respiratory drive, respiratory arrest, and eventually cardiac arrest (2). Emergency medical services (EMS) practitioners are uniquely prepared to manage opioid overdose patients as they are trained to rapidly recognize a clinically significant opioid overdose through assessment of the patient's environment, airway, breathing, circulation and mental status. EMS practitioners can prevent or reverse respiratory arrest through airway management, oxygen administration, artificial ventilation, and the administration of opioid antagonists.