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Sudden cardiac death and substance abuse
A A Adgey1, P W Johnston, S McMechan
1Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, N. Ireland, UK.
Resuscitation
|June 1, 1995
Summary
Volatile substance abuse causes increasing deaths, primarily in young males, often due to cardiac arrhythmias from inhaled substances like butane. Management involves conventional arrhythmia treatment, avoiding sympathomimetics, and early beta-blocker administration.
Area of Science:
- Toxicology
- Cardiology
- Emergency Medicine
Background:
- Volatile substance abuse (VSA) is linked to a rising number of annual deaths.
- Males aged 15-19 years are the most affected demographic.
- Commonly abused volatile substances include fuel gases (butane, propane, gasoline) and solvents (trichloroethane, bromochlorodifluoromethane).
Purpose of the Study:
- To review the mechanisms of sudden death associated with volatile substance abuse.
- To outline appropriate resuscitation strategies for VSA-related cardiac arrest.
Main Methods:
- Review of existing literature on volatile substance abuse and associated mortality.
- Analysis of mechanisms contributing to sudden cardiac death in VSA.
- Discussion of recommended resuscitation protocols.
Main Results:
- Volatile substances sensitize the heart to catecholamines, leading to fatal cardiac arrhythmias.
- Anoxia, respiratory depression, vagal stimulation, and aspiration can contribute to death.
- Butane inhalation may cause severe laryngeal edema and laryngospasm.
- Sudden deaths from VSA are often unwitnessed, making resuscitation rare.
Conclusions:
- Conventional treatment for cardiac arrhythmias is recommended.
- Sympathomimetic drugs should be avoided in VSA-related cardiac arrest.
- Early administration of beta-adrenergic blocking agents is advised to protect the heart.
- Avoid early intubation if laryngospasm is suspected due to the inhalational agent.