Methadone
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Heart arrest: case report A 55-year-old woman experienced heart arrest due to opioid intoxication following methadone pump replacement. The woman, who had been receiving IV methadone 10 mg/h via a SC infusion pump for the last 2 months for idiopathic chronic pelvic pain, underwent pump replacement of 500mg of methadone. About 90 minutes after the procedure, she developed cyanosis and was transferred to an emergency department. On admission, she had an undetectable central pulse, no breathing movements and presenting rhythm revealed pulseless electrical activity (QRS frequency 60 /min). The woman received continuous chest compressions, ventilation and IV saline. After 12 minutes, her hypoxia corrected and she received saline and epinephrine [adrenaline]. She did not have a central pulse. Her pupils were observed to be miotic and she received IV naloxone. Approximately 150 seconds after naloxone administration, she developed a new organised rhythm with a short QRS and frequency of 140 /min. She had a palpable pulse and became agitated. It was verified that the pump was empty, which corroborated the idea that the heart arrest was due to opioid intoxication. She was transferred to an ICU and received continuous IV naloxone. Four days later, she was extubated. Five days after the event, a head tomography was normal. On day 7, she regained consciousness with a Glasgow Coma Scale score of 15. However, she developed spinal artery syndrome and paraparesis. Martins HS, et al. Should naloxone be prescribed in the ED management of patients with cardiac arrest? A case report and review of literature. American Journal of Emergency Medicine 26: 113.e5-113.e8, No. 1, Jan 2008. Available 801101647 from: URL: http://www.sciencedirect.com - Brazil
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Reactions 1 Mar 2008 No. 1191
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