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Biomedical subjects

K S Merigian

Publications and source records attributed to K S Merigian.

At least 19 recordsLinked to original sources
PubMed1996

Envenomation from the brown recluse spider: review of mechanism and treatment options.

The brown recluse spider in commonly found throughout the midsouth region of the United States. Bites from the brown recluse occur when the spider is trapped in clothing or its nest is otherwise disturbed. The bite may be undetected by the patient until hours or days later when a characteristic lesion develops. Mild reactions to envenomation are usually limited to a lesion only. In some cases, a severe reaction results which can be life-threatening. Although there have been case reports of various pharmacological agents used for the treatment of brown recluse bites, none have been shown to be consistently effective. Therapy for brown recluse bites remains centered around aggressive wound care. Early surgical excision has not been shown to be of benefit and in most cases delays healing. This review focuses on the physiological mechanisms of the brown recluse venom and current treatment options.

Journal Article↗
PubMed1995

Impact of antiseizure medication level on the incidence of sudden unexplained death from epilepsy in patients from an inner city emergency department.

Sudden unexplained death from seizures (SUDS) accounts for death in approximately 10% of the epileptic population. SUDS usually occurs in young males with a history of seizure disorders who are in otherwise good health. No definitive anatomical lesions are found at autopsy that explain death. There is however, a correlation between SUDS and subtherapeutic levels of antiseizure medications. The purpose of this study was to retrospectively review and compare drug levels from a seizure patient that presented to an inner city emergency department to those from the medical examiners office. This study was prompted by a wrongful death claim for substandard care in a known seizure disorder patient. The claim alleged that the death was directly attributed to subtherapeutic seizure medication levels. We report the results from 150 seizure patients that presented to the emergency department with a chief complaint of a recent seizure and of 163 patients that were examined post mortem. 58% of the emergency department patients who were taking phenytoin, 79% taking carbamazapine and 82% of the patients taking phenobarbital had subtherapeutic levels. No patient in this population died and only 13% required hospital admission. These levels were comparable to the post mortem population.

Journal Article↗
PubMed1995

Successful treatment of amoxapine-induced refractory status epilepticus with propofol (diprivan)

Tonic-clonic seizure activity is a recognized complication of amoxapine overdose. Refractory drug-induced status epilepticus is associated with significant morbidity and mortality. Standard regimens for controlling status epilepticus may be ineffective for aborting drug-induced seizures. The authors report the case of a 30-year-old woman who presented with an amoxapine overdose that deteriorated into status epilepticus refractory to conventional therapy. Propofol given by intravenous bolus and maintenance infusion successfully halted the patient's seizure activity. This case suggests that propofol may be effective as an anticonvulsant in refractory drug-induced status epilepticus.

Adult↗
PubMed1994

Cutaneous exposure to warfarin-like anticoagulant causing an intracerebral hemorrhage: a case report.

A case of intercerebral hematoma due to warfarin-induced coagulopathy is presented. The 39-year-old woman had spread a warfarin-type rat poison around her house weekly using her bare hands, with no washing post application. Percutaneous absorption of warfarin causing coagulopathy, reported three times in the past, is a significant risk if protective measures, such as gloves, are not used. An adverse drug interaction with piroxicam, which she took occasionally, may have exacerbated the coagulopathy.

Administration, Cutaneous↗
PubMed1991

Plasma catecholamine levels in cyclic antidepressant overdose.

Cyclic antidepressant overdose is a major cause of morbidity and mortality in self-poisoned patients. The major cause of mortality with cyclic antidepressant overdose is cardiotoxicity. We determined plasma catecholamine levels in 41 symptomatic acute overdose patients to identify interactions between QRS duration (a marker for cardiotoxicity) and a presumed hyper-adrenergic state. Using a linear multivariable regression analysis, QRS duration correlated with the presence of cyclic antidepressant, plasma norepinephrine levels, the ratio of norepinephrine to epinephrine level, and pulse rate (p less than 0.001, r2 = 0.42). Commensurate physiologic changes were not found in the presence of elevated catecholamine levels in the cyclic antidepressant overdose group. One possible explanation for the blunted systemic response to the elevated catecholamine levels is adrenergic desensitization. Investigation of serial catecholamine levels during cyclic antidepressant overdose may lead to modification of our current theories of cardiotoxicity and therapy.

Adolescent↗
PubMed1990

Prospective evaluation of gastric emptying in the self-poisoned patient.

The authors prospectively studied the effect of gastric emptying (GE) and activated charcoal (AC) upon clinical outcome in acutely self-poisoned patients. Presumed overdose patients (n = 808) were treated using an alternate day protocol based on a 10-question cognitive function examination and presenting vital sign parameters. Asymptomatic patients (n = 451) did not receive GE. AC was administered to asymptomatic patients only on even days. GE in the remaining symptomatic patients (n = 357) was performed only on even days. On emptying days, alert patients had ipecac-induced emesis while obtunded patients received gastric lavage. AC therapy followed gastric emptying. On nonemptying days, symptomatic patients were treated only with AC. No clinical deterioration occurred in the asymptomatic patients treated without GE. AC use did not alter outcome measures in asymptomatic patients. GE procedures in symptomatic patients did not significantly alter the length of stay in the emergency department, mean length of time intubated, or mean length of stay in the intensive care unit. Gastric lavage was associated with a higher prevalence of medical intensive care unit admissions (P = .0001) and aspiration pneumonia (P = .0001). The data support the management of selected acute overdose patients without GE and fail to show a benefit from AC in asymptomatic overdose patients.

Adolescent↗
PubMed1988

Hyperthermia, hypertension, hypertonia, and coma in a massive thioridazine overdose.

This report characterizes an atypical presentation of a thioridazine overdose. Clinical manifestations included wide Q.R.S. complex, hyperthermia, hypertension, hypertonia, and coma. Plasma catecholamine levels were markedly elevated. The patient was treated with dantrolene sodium and supportive care. The patient's condition improved over time, with questionable response to dantrolene sodium. Supportive care was the mainstay of treatment.

Acute Disease↗
PubMed1988

Use of abbreviated mental status examination in the initial assessment of overdose patients.

Application of formal mental status testing in the emergency department (ED) to assess cognitive function has been hampered by the lack of a rapidly applied instrument. An Abbreviated Mental Status Examination (AMSE) with 10 test items that can be administered within five minutes by nursing personnel is described. Evaluation of the instrument on 296 ambulatory ED patients with grossly normal neurologic function showed that 93% of patients had a total score of seven or more correct answers and 83% of patients had eight or more correct answers. Application of the AMSE to 375 acute drug overdose patients at the same hospital showed a significant correlation with Glasgow Coma Scale (GCS) score. An AMSE score of seven or less was found to be more sensitive than a GCS score of 13 or less for admission to the intensive care unit (ICU) and complications in the ICU (P less than 0.001). The AMSE score may serve as a useful tool for stratifying cognitive function in acute drug overdose patients and for identifying patients at increased risk for an adverse outcome from their overdose.

Adult↗
PubMed1987

A comparison of blind nasotracheal and succinylcholine-assisted intubation in the poisoned patient.

In the patient obtunded by drug intoxication, the optimal method of airway protection prior to gastric emptying is not clear. We report a prospective randomized trial of two methods of intubation in this patient population. Fifty-two overdose patients with Glascow Coma Scale scores of 12 or less were intubated either orotracheally after succinylcholine administration or nasotracheally. Success rate, time to intubate, difficulty, and complications of intubation were compared for the two groups. We found a success rate of 100% (23 of 23) for succinylcholine assisted intubation (SAI) versus 65% (19 of 29) success with blind nasotracheal intubation (BNI). Mean time to intubate was 64 seconds and 276 seconds in the SAI and BNI groups, respectively. Eighty-six percent (19 of 22) of patients were intubated successfully in less than 120 seconds in the SAI group versus 37% (10 of 27) in the BNI group (P less than .005). In the SAI group, the mean number of attempts was 1.3 per patient, (range, one to three) with 96% (22 of 23) having two or fewer attempts. No complications were identified. In the BNI group, the mean number of attempts was 3.7 per patient, (range, one to 13) with 45% (13 of 29) having two or fewer attempts (P less than .005). Sixty-nine percent of the BNI group experienced epistaxis, 17% had vomiting, and 10% aspirated. We conclude that SAI is a safe and effective method of airway protection in the obtunded poisoned patient. Complications and difficulty in intubation were significantly less with SAI than with blind nasotracheal intubation.

Adult↗
PubMed1987

Cocaine intoxication: hyperpyrexia, rhabdomyolysis and acute renal failure.

Cocaine has become the recreational drug of abuse of the eighties. The prevalence of cocaine has been manifesting increases in intoxications and poisonings. Acute overdoses have been associated with hyperthermia, agitation, paranoid ideation, status epilepticus, ventricular fibrillation, ventricular tachycardia, myocardial infarction, coma, and death. This is the first reported case of cocaine intoxication resulting in severe hyperthermia, bizarre behavior, rhabdomyolysis, and acute renal failure. Treatment consisted of cooling via iced intravenous fluids, nasogastric lavage with ice water, and benzodiazepine sedation. To our knowledge, there is no case report which supports the allusions that cocaine intoxication may cause rhabdomyolysis and acute renal failure.

Acute Kidney Injury↗