The new guidelines are designed primarily for North American healthcare professionals who treat adults and children who are critically ill because of poisoning, including intentional and unintentional drug overdose, chemical exposure, and drug-drug interactions, the authors note.
The guidelines were compiled by the Critical Poisoning Writing Group, which includes experts from emergency medicine, pediatrics, medical toxicology, pharmacology, critical care, emergency medical services, education, research, and nursing. Group members were appointed by the AHA Emergency Cardiovascular Care Science Subcommittee and were approved by the AHA Manuscript Oversight Committee.
Other key points include the following:
Naloxone administration may reverse respiratory arrest due to opioid overdose, preventing progression to cardiac arrest.
Give high-dose insulin therapy early in the treatment of patients with beta blocker and calcium channel blocker poisoning, Lavonas noted.
Standard advanced life support plus sodium bicarbonate is appropriate for life-threatening dysrhythmias caused by cocaine or other sodium channel blockers.
If cyanide poisoning is suspected, clinicians should not wait for confirmatory testing; treatment should begin immediately with hydroxocobalamin (preferred) or sodium nitrite plus sodium thiosulfate.
Digoxin-specific immune antibody fragments can reverse life-threatening dysrhythmias from digoxin poisoning.
Use of 20% intravenous lipid emulsion can be efficacious in the resuscitation of life-threatening local anesthetic toxicity, especially from bupivacaine, Lavonas indicated.
Sedation is recommended for patients with severe agitation from sympathomimetic poisoning to manage hyperthermia and acidosis, prevent rhabdomyolysis and injury, and allow evaluation for other life-threatening conditions.
Although flumazenil reverses central nervous system and respiratory depression from benzodiazepine poisoning, risks and contraindications, provided in the guidelines, limit its use.
VA-ECMO can be lifesaving for patients with cardiogenic shock or dysrhythmias that are refractory to other treatments.
Of the 73 guideline recommendations, only two are supported by level A evidence; three are supported by level B-randomized evidence, 12 by level B-nonrandomized evidence, and the rest by level C evidence.
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