Yes, I know what happens in the movies often has no basis whatsoever, but I’m curious about the scene in Pulp Fiction where the gangster’s overdosing wife is revived by a hyperdermic of adrenalin straight through her breastbone and into her heart. Is this complete bullshit or what? I can understand how adrenalin would be appropriate, but why does it need to be administered direct to the heart (why not just into the bloodstream?) Even assuming straight to the heart is necessary, wouldn’t it be easier to go between the ribs and not through the breastbone? Is going through the breastbone even possible with a needle? What happens if the needle breaks off?
Here’s a similar thread about heart injections: http://boards.straightdope.com/sdmb/showthread.php?threadid=60421
To quote catmandu42:
I’m sorry SmackFu, but you clearly haven’t been paying much attention to anything at all related to emergency medicine.
I have been part of numerous resucitation procedures during my career, and I have NEVER seen a direct injection of adrenalin to the heart muscle through the chest wall. Almost every administration of adrenalin I have seen has been intravenous, with the occasional dose given via the endotracheal tube used to provide a patent airway.
External cardiac compressions provide the mechanism for moving blood via the alternating compression/decompression of the chest cavity, which generates alternating positive/negative pressure in the major blood vessels, such as the aorta and the vena cavae. It is this mechanism that shifts blood, not the erroneous ‘squeezing of the heart’ concept originally held to when CPR was invented.
Under the resus protocol practised by ambulance staff in South Australia, intravenous adrenalin is always infused via an established line running 0.9% normal saline, to ensure that it is flushed quickly into systemic circulation. If additional infusion pressure is required, one simply squeezes the saline bag.
I think you may have confused the direct injection technique with another technique called pericardial centesis, where blood/fluid is removed from the tough sack surrounding the heart muscle, to allow it to fill completely and contract normally.
Dvious means is exactly right, the epi in the heart injection is what’s commonly called “junkie lore”. It did used to be given directly into the heart, but it’s been found to work as well, if not better thru endotracheal tubes, or in a vein if cpr is being given. It’s probably still done as a last resort if noone’s got ET tubes or knows cpr but has a big syringe with adrenaline in it.
During the movie, i found myself yelling at the screen “give her naloxone, you idiot, not epi!”
Probably means I’m working too hard.
Naloxone reverses the effects of opiates.
I admittedly don’t know the answer to the adrenaline injection question, but I do remember hearing something about a way to bring people down from a “bad trip” on LSD. It was told to a reporter from High Times magazine by Wavy Gravy, a yippie legend and one of the people who ran the medical, or “freak out,” tent at Woodstock. He said that a 500 milligram dose of powdered B-5(maybe it was B-3) would bring a person out of a bad trip in about 5 minutes. I hate to be a thread-jacker, but has anyone else ever heard of this? In my experience I’ve never had to be “brought down.”
I have recently read an article (I think it was in JEMS magazine) referring to a study done to compare the efficacy of endotrachael vs intravenous routes of drug administration. In short, it confirmed what we already knew: that intravenous administration is far more effective than via an ETT. Of course, our protocols already suggest that anyway, by recommending greater doses to achieve the same effect as an IV dose.
(JEMS is the Journal of Emergency Medicine - the “trade magazine” in the US for paramedics and EMT’s).
Since there’s no real lethal dose for LSD (I don’t know the MD50 right off the top of my head, but I do know that it’s just not that toxic!), I don’t know if you can actually call it an “overdose”. I don’t know about the vitamin B thing, but do I know if you end up in the ER with a bad trip, they’ll give you thorazine to calm you down and/or knock you out until the drug wears off. Then you probably get to have a nice chat with the authorities in the morning. In my experience, the best thing to do for someone who is having a bad trip is to try and distract them (while the LSD tripper is capable of wild swings of emotion, they also have very short attention spans) and calm them down by talking to them. Just assure them that everything’s OK, that they think they’re going crazy right now, but, in fact, they are not, and everything will be back to normal in the morning. Assuming all you have taken is LSD, the “bad trip” is all in your head. If you’re mixing drugs (and I don’t think you should ever mix anything with acid), then it could be more complicated…
The LD50 for LSD is…infinity. You simply can’t die from it, even if you take 50g of the stuff. However, “street” acid is often cut with strychnine, which CAN kill you if you take too much. (I’ve never heard of this actually happening to anyone, though, as far as street acid goes – you’d have to take something like 5,000 sheets to get a toxic dose of strychnine.)
Drugs given to reverse the effects of LSD (thorazine, mellaril) typically work by “fixing” the psychotic side effects, and NOT by neutralizing the drug itself, which generally leaves your system within a couple hours.
“I can understand how adrenalin would be appropriate, but why does it need to be administered direct to the heart (why not just into the bloodstream?) Even assuming straight to the heart is necessary, wouldn’t it be easier to go between the ribs and not through the breastbone? Is going through the breastbone even possible with a needle?”
Intracardiac injection of epinephrine (adrenaline) used to be recommended as part of CPR under some circumstances. As has been pointed out, recommendations change.
The idea was not to inject into the muscle but to inject into the left ventricle. The idea was that the epinephrine-rich blood in the ventricle would travel immediately into the coronary arteries (which originate near where the left ventricle joins the aorta) and pass directly into the heart muscle. In this way, the epinephrine was thought to reach the heart muscle faster than if it were injected in a vein and had to slosh around over a longer distance before reaching the heart.
To inject into the heart you need a long needle but you also have to miss the sternum and ribs (not hard to do). Any needle stout enough to pierce the sternum would make a bigger hole in the heart than you would like. If the needle broke off and you were a licensed health care provider (not a gangster or Hollywood actor) you would probably be sued.
This MSDS for LSD suggests that there is an LD50 dose for LSD and humans, since they list it for various animals:
At 1800 ug/Kg, a 150 lb. man would need to ingest 122 mg, or about 1200 doses of LSD to reach LD50 (i.e. 50% chance of death). Of course, they don’t actually list an LD50 for humans, so YMMV
How the hell could you OD on LSD unless it was laced with something? The only way LSD could kill you is if you were at a port and they were unloading it and the crane broke and about two tons of the stuff fell on you and crushed you.
At the answering service I manage, we dispatch calls after hours for a rural ambulance service. The Administrative Supervisor on call assures me that if you OD in Dickenson Co., VA, you may still get a shot in the heart. From his tone, I deduced that it may not be for lack of higher-tech alternatives, either.
A coworker of mine whose daughter ended up in the ER a month or so ago on a “bad trip” tells me that she was given I.V. fluids due to dehydration (from sweating and running around all night), strapped to a gurney, but given no drugs. She also related that she did not have to speak with the authorities. She says they were actually really nice to her, considering, and the speech the ER doc gave her convinced her not to do it again.