Biomedical subjects

Sam D Shemie

Publications and source records attributed to Sam D Shemie.

21 records · Page 2Linked to original sources

PubMed2003

Massive diltiazem overdose treated with extracorporeal membrane oxygenation.

OBJECTIVE: To describe a case of massive diltiazem overdose with a good outcome achieved after early and aggressive supportive therapy. DESIGN: Case report. SETTING: Pediatric Critical Care Unit. PATIENT: Sixteen-year-old adolescent girl. MEASUREMENTS AND MAIN RESULTS: A 16-yr-old adolescent girl presented to the emergency department 6 hrs after the intentional ingestion of 40 300-mg sustained-release diltiazem tablets (12 g of Cardura CD). She was hypotensive and required a glucagon and epinephrine infusion despite initial fluid resuscitation with saline and intravenous calcium (1 g). Multiple asystolic cardiac arrests ensued which became increasingly refractory to high-dose epinephrine. Hemodynamic support was achieved with a 48-hr period of extracorporeal membrane oxygenation for atrial standstill. Severe multiorgan dysfunction ensued (cardiac, neurologic, renal, hepatic, gastrointestinal, hematologic, and metabolic). Plasma diltiazem and its metabolites were measured and its half-life was reported between 28 and 48 hrs. A sustained decline in plasma diltiazem levels and its metabolites was not observed after two periods of charcoal hemoperfusion. Recovery of organ function occurred with sinus rhythm noted on the ninth day. The patient made a full recovery and was discharged from the critical care unit after 15 days. CONCLUSIONS: Although massive calcium channel blocker overdose can produce profound and prolonged cardiac or multiorgan dysfunction, its toxic effects may be reversible. Supportive therapy, particularly of the cardiovascular system, is the most important goal.

Adolescent↗

PubMed2002

Pro/con ethics debate: should mechanical ventilation be continued to allow for progression to brain death so that organs can be donated?

Organ transplants continue to redefine medical frontiers. Unfortunately, current demand for organs far surpasses availability, waiting lists are long and many people die before the organ they desperately need becomes available. One proposed way to increase organ availability is to admit patients to the ICU with severe neurological injuries, for a trial of therapy. If the injury is irretrievable, discussions would then focus on extending ventilation for potential brain death/organ donation if a prior wish to donate is known or if the substitute decision maker consents. The following debate discusses the ethical dilemmas of waiting for brain death.

Adolescent↗

PubMed2002

Transfusion-associated graft versus host disease.

OBJECTIVES: To review the epidemiology, pathophysiology, therapeutic and preventive strategies of transfusion associated graft versus host disease (TA-GVHD) and relate the findings to the critically ill child. DESIGN: Review article of published medical literature related to TA-GVHD. DATA SOURCES: Medline, bibliography search, published national and institutional guidelines. STUDY SELECTION: Original publications including prospective studies, case reports, case series, laboratory studies, and animal work. DATA EXTRACTION: Data were extracted manually after we reviewed selected articles and assessed their contribution to knowledge of TA-GVHD. DATA SYNTHESIS: New and significant historic information from the selected publications relating to incidence, therapy, prevention, and complications of preventive therapy of TA-GVHD was incorporated. CONCLUSIONS: Pediatric critical care practitioners should be aware of this preventable but fatal complication of cellular blood product transfusion. High-risk categories include congenital and acquired immunodeficiency, younger age, transfusion of blood donated by family members, and transfusion with fresh whole blood. Children at risk for the development of TA-GVHD include neonates, infants, and children with congenital heart disease, not restricted to children with "classic" DiGeorge syndrome. At present, risk identification and targeted prevention are the only methods to manage TA-GVHD. Aside from minimizing cellular blood product exposure, blood product irradiation is the only established and widely available method to prevent TA-GVHD. Transfusion guidelines need to reflect a balance between the incidence of TA-GVHD and the costs of instituting irradiation to selected groups or as routine transfusion policy.

Journal Article↗