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(Circulation. 2005;112:IV-126 – IV-132.)
© 2005 American Heart Association, Inc.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Part 10.2: Toxicology in ECC

	Introduction

 
Poisoning is an infrequent cause of cardiac arrest in older patients, but it is a leading cause of cardiac arrest in victims <40 years of age.^1–4 When a patient with poisoning is in cardiac arrest or near-arrest, immediate support of airway, breathing, and circulation is essential. Urgent consultation with a medical toxicologist or certified regional poison center is recommended^5,6 because standard guidelines for emergency cardiovascular care may not be optimal in the management of acute poisoning and overdose.

This section presents recommendations for the care of the patient with a toxicologic problem. Some recommendations are evidence-based, but most toxicology research in this area consists primarily of small case series (LOE 5), case reports, and animal studies (LOE 6). Hence many of these recommendations are based on expert consensus, and further research is needed to validate them.

Clinicians may see a patient with a history of ingestion of an unknown substance. In such cases the clinician must be familiar with common toxidromes and their therapies. To assist during such encounters, Table 1 lists drug-induced cardiovascular emergencies or altered vital signs, potential therapies to consider, and interventions that should be used with caution.

View this table: [in this window] [in a new window]   TABLE 1. Drug-Induced Cardiovascular Emergencies or Altered Vital Signs*:Therapies to Considerand Contraindicated Interventions

Clinicians may also encounter patients with a history of known ingestion. Then the clinician must anticipate the complications from that substance and be prepared to treat them. Table 2 lists potentially cardiotoxic drugs, signs of toxicity, and therapy to consider.