Near-fatal Episode Research Articles

Systemic Intravenous Thrombolysis for Massive Pulmonary Embolism after Intracranial Surgery for Traumatic Head Injury: When Absolute Becomes Relative!

AbstractIntravenous thrombolysis is the preferred treatment for massive pulmonary embolism with hemodynamic instability, when there are no contraindications to the therapy. However, when absolute contraindications to thrombolysis are present, clinicians are at a crux, especially when mechanical thrombectomy is also not possible. We present a case of a 40-year-old man with polytrauma with head injury who developed massive pulmonary embolism requiring intravenous thrombolysis on day 15 after decompressive craniotomy—possibly a first in the literature. The patient, however, successfully recovered from this near-fatal episode. With this report, we wish to highlight that at a near-dying situation, no contraindication is absolute, and all possible efforts must be made by the clinician to save the patient.

Risk factors for severe anaphylaxis in the United States

BackgroundAnaphylaxis is an acute systemic allergic reaction and may be life-threatening. ObjectiveTo assess risk factors associated with severe and near-fatal anaphylaxis in a large observational cohort study. MethodsWe analyzed administrative claims data from Medicare Advantage and privately insured enrollees in the United States from 2005 to 2014. Severe anaphylaxis was defined as anaphylaxis resulting in hospital or intensive care unit (ICU) admission, requiring endotracheal intubation, or meeting criteria for near-fatal anaphylaxis. ResultsOf 38,695 patients seen in the emergency department for anaphylaxis during the study period, 4,431 (11.5%) required hospitalization, 2,057 (5.3%) were admitted to the ICU, 567 (1.5%) required endotracheal intubation, and 174 (0.45%) were classified as having a near-fatal episode. Multivariable analysis revealed that medication-related anaphylaxis (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.38–1.63; P < .001), age of 65 years or older (OR, 3.15; 95% CI, 2.88–3.44; P < .001), and the presence of cardiac disease (OR, 1.56; 95% CI, 1.50–1.63; P < .001) or lung disease (OR, 1.23; 95% CI, 1.16–1.30; P < .001) were associated with increased odds of severe anaphylaxis requiring any hospital admission, ICU admission, or intubation or being a near-fatal reaction. ConclusionIn this large contemporary cohort study, 11.6% of patients had severe anaphylaxis. Age of 65 years or older, medication as a trigger, and presence of comorbid conditions (specifically cardiac and lung disease) were associated with significantly higher odds of severe anaphylaxis. Additional studies examining risk factors for severe anaphylaxis are needed to define risk assessment strategies and establish a framework for management.

Mutation of NLRC4 causes a syndrome of enterocolitis and autoinflammation

Upon detection of pathogen-associated molecular patterns, innate immune receptors initiate inflammatory responses. These receptors include cytoplasmic NOD-like receptors (NLRs), whose stimulation recruits and proteolytically activates caspase-1 within the inflammasome, a multi-protein complex. Caspase-1 mediates the production of interleukin-1 family cytokines (IL1FCs), leading to fever, and inflammatory cell death (pyroptosis)1,2. Mutations that constitutively activate these pathways underlie several autoinflammatory diseases with diverse clinical features3. We describe a family with a previously unreported syndrome featuring neonatal-onset enterocolitis, periodic fever, and fatal/near-fatal episodes of autoinflammation caused by a de novo gain-of-function mutation (p.V341A) in the HD1 domain of NLRC4 that co-segregates with disease. Mutant NLRC4 causes constitutive Interleukin-1 family cytokine production and macrophage cell death. Infected patient macrophages are polarized toward pyroptosis and exhibit abnormal staining for inflammasome components. These findings describe and reveal the cause of a life-threatening but treatable autoinflammatory disease that underscores the divergent roles of the NLRC4 inflammasome.

Automated Noninvasive Clinical Dehydration Detection Device

Dehydration is a common problem in healthy individuals as well as the elderly and chronically ill. People are often poorly attuned to hydration, and despite widespread awareness of the problem, fatal and near-fatal episodes occur frequently. Typical indicators of hydration status include changes in body weight, urine specific gravity, blood plasma levels, and bioelectrical impedance. Challenges to estimating hydration status from these indicators include the invasive nature of some methods as well as the cost and time required. We have developed a noninvasive device for monitoring hydration status. Our design is inspired by the traditional clinical protocol that approximates fluid loss on the order of 1-2% dehydration by assessing radial pulse before and after a supine to standing transition. The prototype comprises an inertial measurement unit (Xsens MTi) and a wearable heart rate monitor (Polar S810i). In order to compare heart rate behavior under normal and low hydration levels, fluid loss equivalent to 1-4% of the baseline body weight was induced by exercise in three healthy subjects during two data collection sessions. In the first (control) session, subjects replaced fluids every 15 minutes during exercise to maintain their body weight within 0.2% of their baseline value. Fluids were not replaced during the second (test) session, and subjects lost an average of 1.2% of their body weight. Heart rate and body position measurements were recorded before and after exercise while subjects performed repeated supine-to-standing movements and knee-to-chest stretching exercises (supine position only). All post-processing was performed using MATLAB (The MathWorks). Average heart rate was calculated over a 10 second period. Pilot data demonstrates the device's ability to detect hydration changes on the order of 1% in one-third the time required by the traditional clinical protocol (30 seconds compared to 90 seconds). The average rise time from baseline to maximum heart rate and the maximum heart rate following supine-to-standing transitions were significantly longer and greater, respectively, in the dehydrated subjects. Although not statistically significant, the average heart rate during knee-to-chest stretching exercises was elevated in the dehydrated state.

Out-of-Hospital Administration of Corticosteroids to Patients with Acute Asthma: A Case Study and Literature Review

Objectives Asthma is an important health problem in Australia with more than 2.2. million Australians currently diagnosed with Asthma. Asthma is associated with significant mortality and frequent use of emergency medical services. The objectives of this paper were to: a) present a case study of a near-fatal episode of severe acute asthma in which the patient was administered corticosteroids by an Ambulance Service of New South Wales Extended Care Paramedic; b) review the epidemiology and pathophysiology of acute asthma as well as current pharmacotherapy in asthma management; and c) conduct a literature search and critical appraisal of existing evidence supporting the out-of-hospital administration of corticosteroids for acute asthma by paramedics. Methods The purpose of the literature search was to identify comparative studies of adult patients with “acute” asthma treated by paramedics with corticosteroids prior to arrival at the emergency department (ED) to evaluate whether this intervention is associated with improved outcomes. A literature search of databases included the Cochrane Database of Systematic Reviews (Cochrane Reviews Issue 4 2008), Cochrane Central Register of Controlled Trials (Clinical Trials), Medline (1950- November 2008), EMBASE and CINAHL. A pre-hospital filter was applied to increase the sensitivity of the searches as appropriate. MeSH headings included exp/asthma, exp/hydrocortisone, exp/prednisone, exp/prednisolone and exp/glucocorticoids. Searched text words included asthma, hydrocortisone, prednisone and prednisolone. Titles and abstracts of interest were inspected to identify relevant articles with the full text of selected articles retrieved. Identified papers were independently appraised by two reviewers. Results Only two original studies were identified. The first was a retrospective comparative study of adult patients with moderate to severe asthma who received 125 mg methylprednisolone prior to transport to hospital or after arrival in the ED. The second study was a retrospective chart review to determine whether the out-of-hospital administration of systemic steroids to asthmatic patients had any effect on hospital admission rates. Conclusion Corticosteroids have been widely used in the hospital setting for many years in the treatment of acute asthma and there is good evidence to support their early administration in an ED setting. Out-of-hospital studies provide only weak evidence of benefit. There is insufficient evidence of adequate quality to determine if corticosteroids should be routinely used by paramedics. A prospective randomised controlled trial is needed to determine the true value of early corticosteroid administration in the ambulance setting.

Rate and Characteristics of Asthma Exacerbations: The ASMAB I Study

The aim of this study was to determine the incidence and clinical characteristics of asthma exacerbations seen by emergency services in Barcelona, Spain (the ASMAB-I study). The emergency services considered in the study served a population of 1 203 598 inhabitants aged over 14 years. Episodes treated in hospital emergency departments and by emergency services called to patients' homes over a period of 129 days were included in the study. In total, 831 episodes of exacerbation were identified; 523 were seen in 3 university hospitals, 113 in secondary hospitals, and 195 by emergency services at the patient's home. Twenty of the patients seen at home were subsequently taken to hospital. The mean frequency was 6.4 episodes per day, corresponding to a daily incidence of 0.53 exacerbations per 100 000 inhabitants (95% confidence interval, 0.46-0.56 exacerbations/100 000 inhabitants) and 8.2 per 100 000 asthmatic patients (95% confidence interval, 6.89-8.41 exacerbations/100 000 asthmatic patients). Of the 276 episodes treated between Monday and Thursday in university hospitals, 66 patients (24%) reported acute onset and 14 (5%) sudden onset. Only 85 patients (31%) regularly used inhaled corticosteroids and only 33 (12%) added oral corticosteroids in the 12 hours prior to consulting emergency services. In 16% of cases the episode was classified as severe and in 3% near fatal. Eighty-two patients (30%) were ultimately admitted to hospital: 12% of mild exacerbations, 39% of moderate exacerbations, 62% of severe episodes, and 100% of near-fatal episodes. The Charlson comorbidity index was higher in patients admitted to hospital (P< .001). In the 28 patients readmitted to hospital (10%), antibiotics (P< .001) and ipratropium bromide (P< .0001) had been prescribed less often at the time of discharge after the first hospital admission. The rate of asthma exacerbation established in this study may be a useful indicator of the degree of control of the disease and may serve as a reference to confirm future short-term or lasting increases in asthma exacerbation. Rapid onset (acute or sudden) is common and many patients are not receiving appropriate treatment prior to hospital admission. Severe exacerbation is common in our practice setting. Hospital admission is related to severity and comorbidity. Patients who are readmitted to hospital had less often received antibiotic treatment and ipratropium bromide when discharged previously.

Understanding the reasons for poor asthma outcomes in ethnic minorities: welcome progress, but important questions remain

Understanding the reasons for poor asthma outcomes in ethnic minorities: welcome progress, but important questions remain

From the heart to the soul

A previously fit, 78-year-old retired farmer established on haemodialysis for 5 years, presented with anorexia and severely altered mental state, singing ecclesiastical hymns all day long. Clinical examination revealed only the presence of an already known pansystolic murmur at the mitral area. He was not on any medication that could be implicated in causing acute confusion, he had never been treated with aluminium-containing phosphate binders in the past and his wife confirmed that he had not ingested star fruit or unusual mushrooms recently. His white cell count was 12 000 (89% neutrophils), Hb 9.8 g/dl with normal mean corpsular volume (MCV), erythrocyte sedimentation rate (ESR) 98 and C-reactive protein(CRP) 15mg/dl. Full biochemistry, arterial blood gases, three sets of blood cultures, urine culture, chest x-ray, thyroid function tests, Treponema Pallidum Haemaglutination Assay and CT head were all normal. His disturbed psychological and mental state was gradually deteriorating with intense ideas of persecution. He was refusing food and was continuously murmuring incomprehensible religious hymns. There was no pyrexia [Pyrexia1⁄4Fever (origin greek ‘pyr’ meaning fire, pyrexial1⁄4 somebody ‘who is on fire’)] or other new clinical signs but he had persistently raised ESR and CRP, suggesting an organic cause for his symptoms. A repeat full septic screen (including a lumbar puncture with India Ink staining for cryptococci), clotting, Vit B12 levels, virology and vasculitis screen, Brucella and Chlamydia titres and bone marrow aspiration for tuberculosis were all negative. There was, however, a strongly positive rheumatoid factor (RF). Within the next few days the patient’s clinical condition deteriorated significantly to the extent that he was unable to communicate with his environment. Examination was again unremarkable with no focal neurology and no pyrexia. Because of the combination of positive RF and CRP, repeat blood cultures were taken with the request to be incubated for 7 days for the HACEK group of bacteria (Haemophilous, Actinobacillus, Cardiobacterium, Eikenella and Kingella), known to be involved in infective endocarditis. A transoesophageal echocardiogram was requested but, due to a long waiting list, a trans-thoracic Echocardiogram was first performed by the cardiology team which was reported as showing mild/moderate mitral regurgitation but no vegetations. The patient’s condition deteriorated even more to the extent that we were contemplating the cancellation of his transoesophageal echocardiogram when he was called for it, as he was so ill. The latter, however, revealed the presence of severe mitral regurgitation with a posterior leaflet vegetation. He was started on benzyl penicillin, gentamicin and vancomycin. Within 48 h his general condition improved. Seven days into treatment he was back to normal, eating and drinking. His blood cultures remained negative. He continued antibiotics for a total of 6 weeks and now continues on haemodialysis thrice weekly and occasionally sings the odd ecclesiastical hymn as a reminder to us all of his near-fatal episode. Correspondence and offprint requests to: Polycarpos Polycarpou. Email: drpolys@cytanet.com.cy Nephrol Dial Transplant (2007) 22: 945–948

Acute severe asthma.

Acute severe asthma remains a major economic and health burden. The natural history of acute decompensations is one of resolution and only about 0.4% of patients succumb overall. Mortality in medical intensive care units is higher but is less than 3% of hospital admissions. "Near-fatal" episodes may be more frequent, but precise figures are lacking. However, about 30% of medical intensive care unit admissions require intubation and mechanical ventilation with mortality of 8%. Morbidity and mortality increase with socioeconomic deprivation and ethnicity. Seventy to 80% of patients in emergency departments clear within 2 hours with standardized care. The relapse rate varies between 7 and 15%, depending on how aggressively the patient is treated. The airway obstruction in the 20-30% of people resistant to adrenergic agonists in the emergency department slowly reverses over 36-48 hours but requires intense treatment to do so. Current therapeutic options for this group consist of ipratropium and corticosteroids in combination with beta2 selective drugs. Even so, such regimens are not optimal and better approaches are needed. The long-term prognosis after a near-fatal episode is poor and mortality may approach 10%.

A Community-Based Study of Near-Fatal Asthma

Purpose of the Study. The objective of this study was to identify possible risk factors associated with fatal and near-fatal asthma in the Washington, DC, area during the time period in which the National Institutes of Health guidelines for the treatment of asthma have been available.Study Populations. Participants were residents of the DC area who had a near-fatal or fatal asthma episode between January 1 and December 31, 1993. The 35 subjects in the study included both adults and children from local intensive care units (ICUs) who required endotracheal intubation for respiratory failure attributable to asthma. There were 33 near-fatal episodes and 2 deaths. Average age was 29.3 (±15.5) years; 14 (45.2%) were under 18 years old. The male to female ratio was 1.58. Eighty-four percent of subjects were African American, 12.9% were Caucasian, and 3.2% were Hispanic.Methods. Participants or proxies were contacted within 2 weeks of their ICU admission. A letter was then sent to explain the study, followed-up by a telephone call for verbal consent and administration of a questionnaire. A supplemental questionnaire was administered to the family member or friend who had the most knowledge of the patient’s activities for the 24 hours before the hospital admission.Results. The demographic information indicated a higher percentage of African Americans (84%) with near fatal asthma compared with the overall African American population in DC (64.8%). For subjects under 18 years old, the average length of diagnosis before the admission was only 2 (±0.05) years, versus 25.5 (±6.6) years for subjects over 18 years old. Forty percent of subjects had daily symptoms and 6.7% had no reported symptoms. Thirty-eight and 7 tenths percent stated they were sick with asthma “all the time” and 16.1% reported never having had an asthma attack prior to this admission. Forty-eight percent had never been hospitalized, 20.7% had been hospitalized 1 to 3 times, and 17.6% had >7 hospitalizations before this admission. Almost 67% had a previous history of intubation. Forty percent had a history of anaphylaxis or drug allergy. Ten percent of the subjects who were under 18 and 44% who were over the age of 18 had a history of smoking. Sixteen percent of the subjects reported not taking any asthma medications and 80% had a prescription for a short-acting |gb2-agonist. Older subjects reported having more severe symptoms than patients <18 years old. Only 64.3% of the subjects contacted a health care provider during the 24 hours before admission. Mortality rates for DC were higher in females and in African Americans.Conclusions. According to this study, age is a risk factor for fatal and near-fatal asthma. The lack of use of an antiinflammatory medications and the reliance on short-acting |gb-agonists were also clear risk factors. Other risk factors, such as lack of access to health care and psychosocial issues, were also noted.Reviewers’ Comments. This article presents several key risk factors for life-threatening asthma that may assist health care providers in recognizing those high-risk asthmatics. There were some weaknesses of the study that were also mentioned by the author, including the lack of a control group, the fact that data were based on self- or proxy reportings, and that the study was limited to 1 urban community. Overall, however, any data on the risk factors for fatal asthma are worth noting.

Observations on asthma mortality.

The rate of death from asthma in the United States has been increasing over the last decade, but such deaths still remain uncommon. Mortality rates differ markedly by region and ethnicity, and case-fatality rates are highest in black men living in inner cities. In general, patients in greatest jeopardy are those with severe, unstable disease who are not being objectively monitored; however, death can occur in anyone if the attack is intense enough. Sudden catastrophic episodes of asthma occur but are very rare. Failure to recognize the seriousness of the terminal episode or to treat the episode appropriately remains the chief contributing cause of poor outcome. Little compelling evidence shows that adverse effects of medications play much of a role in asthma-related death. The disease characteristics that place patients at risk remain inadequately defined. Of those suggested, only a history of recurrent hospitalization and the need for ventilatory assistance are specific enough to be helpful. These characteristics, however, are found in only 36% and 6% of cases, respectively; thus, their absence is of no value in assessing risk. The prognosis after a near-fatal episode of asthma is poor, and approximately 10% of patients die in the year after the event. Given the current state of knowledge, it is wise to view all exacerbations of asthma that last longer than a few days as potentially fatal and to treat them accordingly. This is especially true in patients who have previously had a severe episode of asthma.

Determinants of near fatality in acute severe asthma

purpose: The data extrapolated from cases of acute severe asthma that narrowly miss being fatal may prove valuable in the identification of the factors implicated in mortality. The purpose of this study was, therefore, to identify determinants of near fatality in patients with acute severe asthma. patients and methods: We studied 81 patients with acute severe asthma in whom mechanical ventilation was required. Near fatality was defined as the occurrence of respiratory arrest and/or coma necessitating emergency tracheal intubation and resuscitation. In the cases that were not regarded as near fatal, tracheal intubation was performed electively because of deteriorating arterial blood gas values and/or the anticipation of exhaustion. Various continuous and categorical variables were compared in these two groups of patients. Patients with a hyperacute attack (period from onset of attack to mechanical ventilation less than 3 hours) were specifically sought and studied to determine the impact of such a course on near fatality. results: The “attack duration” (period from onset of attack to mechanical ventilation) was an important determinant of near fatality and of the subsequent clinical course. It was shorter in the group with a near-fatal episode (p <0.03), and hyperacute attacks were uniformly near fatal. The attack duration correlated positively with the duration of the requirement for mechanical ventilation (p <0.01). A longer attack duration was associated with an increased likelihood of the occurrence of major atelectasis (p <0.01). There was no evidence of a relationship between near fatality and the side effects of bronchodilators as regards hypokalemia, arrhythmias, or cardiotoxicity. There was evidence of considerable under-treatment in the patient population as a whole, particularly in regard to the use of corticosteroids. conclusions: A short attack duration is associated with an increased risk of near fatality in acute severe asthma. This is particularly evident in hyperacute attacks. Hyperacute attacks resolve rapidly once bronchodilator therapy has been instituted, suggesting that smooth muscle spasm is the predominant pathogenetic mechanism. The importance of routine anti-inflammatory therapy in mild to moderate asthma requires re-emphasis but, in addition, all patients should be provided with, and educated in the use of, bronchodilator rescue therapy, which should be available at all times. Despite current trends, the use of regular, prophylactic bronchodilator therapy in strict conjunction with anti-inflammatory agents may still be indicated. There is little evidence in the present data obtained from near-fatal cases to support the concept that cardiotoxicity related to bronchodilators contributes significantly to mortality from asthma.

Ventricular buckling: A factor in the abnormal ventriculogram and peculiar hemodynamics associated with mitral valve prolapse

Because of intractable ventricualr arrhythmias after a near-fatal episode of ventricular fibrillation, a patient with idiopathic mitral valve prolapse was subjected to mitral valve replacement. Vector analysis and intraoperative epicardial mapping localized the ectopic focus to the region of the posterior papillary muscle. The patient is alive and well two years after surgery; chronically inverted T waves have become upright. But propranolol and diphenylhydantoin are needed to prevent arrhythmias and T wave abnormalities during standing and exercise. Preoperatively, with the onset of mitral regurgitation and a second rapid phase of prolapse, the ventriculogram was deformed by abnormal midsystolic hyperkinesis at both sites of papillary muscle insertion. Postoperatively, focal hypokinesis appeared in the same areas, implying that they had been retracted by the prolapsing valve. Preoperatively, a papillary tip could be seen entering the mitral ring while coronary arteriography showed late systolic elongation of a small vessel feeding the anterior papillary muscle, suggesting that the papillary apparatus was indeed subject to damaging stress during the abnormal basal movement. Three other persons with severe mitral prolapse (but intact chordae) have had valve repacement and developed qualitatively similar changes in the ventriculogram. Papillary speciments in two showed significant fibrosis. Indication for operation in one of these was edpisodic ventricular fibrillation, which has not recurred. A spectrum of ventriculographic abnormality associated with mitral prolapse could be partly explained by hypokinesis of the papillary loops, variably disguised by retraction stress tansmitted from the billowing leaflets, translocation of blood into the expanding valve sail, and various degrees of unloading into the left atrium. Abnormal intraventicular flow may probably result from associated prolapse of the anterior leaflet and from buckling of the papillary sties toward the mitral annulus. Unusual physical findings in the operated cases and in eight other patients define a clinically recognizable syndrome in which severe prolapse abbreviates left ventricular ejection. Liability to symptoms and to progression of disease seems high in this group.

Tetanus—Difficult diagnosis

The case presented here exemplifies the fact that in a true case of tetanus, diagnosed mainly by past medical history, symptoms are often delayed. It is almost impossible to guarantee recovery, once these symptoms have progressed. It must be noted in the case reported here that many doctors were consulted after this near-fatal episode, and all agree that hindsight is better than foresight as far as diagnosing a true case of tetanus is concerned. The teaching point, in a critique of our therapy, would naturally tend to treat any inability to open the mouth as tetanus as soon as local infectious processes have been ruled out. This, of course, precipitates other symptoms, but it does increase the over-all possibility of survival. With the advent of human serum, and after infectious processes have been ruled out, it would then be my choice to go immediately to massive doses of human serum antitoxin and the supportive care mentioned previously. Recently several investigators have used the paralytic agents, such as succinylcholine or d-tubo-curare, with positive pressure oxygen supplied. These treatments are all part of the supporting care and new methods are continually being tried to aid in the treatment of this ancient but most dreaded disease.

Recognition and treatment of potentially.

Article1 July 1962Recognition and Treatment of Potentially Fatal AsthmaRONALD FELDMAN, M.D.RONALD FELDMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-57-1-29 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIt has frequently been stated and taught that bronchial asthma is not a lethal illness. Our experience has led us to question this concept, and a review of the literature reveals that death from asthma is not rare. This report is based on 12 cases of the syndrome of fatal asthma and includes 2 patients who were resuscitated from near-fatal episodes. We have tried to find clinical and physiological clues which may help us to delineate the asthmatic patient who is apt to die during a paroxysm.Asthma was first described by Aretaeus, some 1,600 years ago, and the history...

Atropine poisoning: report of two cases.

Case Reports1 May 1956ATROPINE POISONING: REPORT OF TWO CASESVICTOR W. GROISSER, M.D.VICTOR W. GROISSER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-5-1020 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough atropine poisoning has occasionally occurred following overdosage with suicidal intent, and after the ingestion of wild berries ofAtropa belladonna, the great majority of reported cases have been therapeutic accidents, resulting from carelessness on the part of physicians, pharmacists, patients and unskilled hospital aides. Fortunately, mortality is uncommon because of the rapid excretion and inactivation of the drug, but the affected patients are often violently ill. After observing a near-fatal episode of poisoning in a child in 1929, Heller1concluded that future morbidity and mortality could be prevented by the use of the word "POISON" on bottles of atropine...Bibliography1. Heller G: Atropine poisoning in a child, J. A. M. A. 92: 800 (Mar. 9) 1929. CrossrefGoogle Scholar2. GoodmanGilman LA: The pharmacological basis of therapeutics, 1941, Macmillan Company, New York. Google Scholar3. HydeTorndorfChinn RWJHI: Absorption from the nasal mucous membrane, Ann. Otol., Rhin. and Laryng. 62: 957 (Dec.) 1953. CrossrefGoogle Scholar4. ListwanWhealy IANC(a) : Mental symptoms in poisoning with atropine and its derivatives, M. J. Australia 1: 581 (Apr. 25) 1953. (b) Morton, H. G.: Atropine intoxication; its manifestations in infants and children, J. Pediat. 14: 755 (June) 1939. (c) Dameshek, W., and Feinsilver, O.: Human autonomic pharmacology: use of acetylbeta methyl choline chloride (Mecholyl) as diagnostic test for poisoning by atropine series of drugs, J. A. M. A. 109: 561 (Aug. 21) 1937. (d) Duggan, P. J.: Mental disturbance following atropine administration, Brit. M. J. 1: 918 (May 1) 1937. (e) Metevier, V. M.: A case of atropine poisoning, Lancet 2: 1232 (Nov. 30) 1935. CrossrefMedlineGoogle Scholar5. Gold H: Cornell Conference on therapy: household poisonings, Am. J. Med. 6: 237 (Feb.) 1949. CrossrefMedlineGoogle Scholar6. Wolfson S: Atropine poisoning—case report, Anesthesiology 7: 566 (Sept.) 1946. CrossrefMedlineGoogle Scholar7. Personal communication. Google Scholar8. WilbournBuxton RBJD: Acute atropine poisoning, review of eight cases, Lancet 2: 211 (Aug. 7) 1948. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication October 10, 1955.†Senior Assistant Surgeon, U. S. Public Health Service; presently Assistant Resident in Medicine, Mount Sinai Hospital, New York, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySome Antagonists of Atropine-Like PsychotomimeticsThe Treatment of Acute Poisoning 1 May 1956Volume 44, Issue 5Page: 1020-1024KeywordsAtropineHospital medicineIntoxicationMedical servicesMortalityPsychosesSodiumSurgeonsTachycardiaUrination Issue Published: 1 May 1956 PDF downloadLoading ...