Toxicological Emergencies.

Poisoning, drug overdose, and adverse drug effects continue to be a common encounter, especially in the intensive care unit (ICU). Patients are often critically ill or have a potential to rapidly deteriorate and warrant ICU admission. Adults suffering from overdoses rarely give a complete and accurate description of the quantity or type of medications ingested. In most adult cases, multiple substances are involved. A tentative diagnosis in most overdose and poisoning cases can be made by physical examination and simple laboratory tests (electrolyte panel, creatinine, serum osmolarity, urinalysis, etc). Supportive care, with particular attention to airway management, oxygenation, and circulation, is the mainstay of treatment. Basic treatment principles include limiting the amount of toxin absorbed, enhancing the elimination of ingested toxin, and preventing the conversion of non-toxic compounds to toxic metabolites. Drugs or poisons, where specific antidotes or effective therapies exist (especially acetaminophen, salicylates, methanol, ethylene glycol, and digitalis), should be aggressively sought and treated after initial stabilization has been accomplished. For those drugs or poisons where specific quantitative tests are available, levels should be obtained before treatment and may be repeated as clinically indicated.

Incidence and Timing of Thrombocytopenia in Patients Receiving Impella Ventricular Assist Device Support.

Impella devices are used in patients with cardiogenic shock or during high-risk percutaneous coronary intervention. Although thrombocytopenia is a known complication in patients receiving Impella support, the incidence and timing of thrombocytopenia remain unknown in this patient population. We retrospectively reviewed adult patients with a left-sided Impella device inserted for more than 24 hours between February 2016 and December 2019. A total of 349 patients were reviewed, and 99 patients were included. Baseline characteristics were similar between patients with thrombocytopenia and those without thrombocytopenia with the exception of median duration of Impella support, which was longer in patients with thrombocytopenia (3.7 vs. 2.1 days; p < 0.001). Thrombocytopenia occurred in 70 patients (70.7%) after Impella implantation. Median time to onset of thrombocytopenia after Impella placement was 2 days with platelet nadirs occurring after 4 days. Thrombocytopenia was mild in our study with 73% of patients having platelet nadirs above 50,000/mL. Duration of Impella support (odds ratio [OR] per day: 1.31; 95% confidence interval [CI]: 1.06-1.56; p = 0.017) and aspirin use (OR: 9.7; 95% CI: 1.46-64.5; p = 0.019) were independent predictors of thrombocytopenia. Thrombocytopenia is common in patients after Impella implantation but is not associated with adverse outcomes.