Unilateral Mydriasis in Helicopter Emergency Medical Services: A Case of Ophthalmic Ipratropium Exposure in Pediatric Asthmatic Cardiac Arrest Prompting Cerebral Herniation Prophylaxis

Q3 Nursing
Jorden B. Dick OMS-1, NRP, FP-C
{"title":"Unilateral Mydriasis in Helicopter Emergency Medical Services: A Case of Ophthalmic Ipratropium Exposure in Pediatric Asthmatic Cardiac Arrest Prompting Cerebral Herniation Prophylaxis","authors":"Jorden B. Dick OMS-1, NRP, FP-C","doi":"10.1016/j.amj.2024.11.001","DOIUrl":null,"url":null,"abstract":"<div><div>This case report describes the medical management for a 14-year-old female patient who suffered cardiac arrest following an acute asthma exacerbation. During air medical transport, the patient developed unilateral mydriasis, a concerning finding often associated with intracranial pathology such as cerebral herniation. Immediate interventions included the administration of hypertonic saline and targeted ventilation strategies to maintain end-tidal carbon dioxide levels within a therapeutic range. Subsequent diagnostic evaluation, including imaging, revealed no neurologic abnormalities, and the mydriasis resolved spontaneously without complications. Ophthalmic ipratropium exposure was suspected as the underlying cause. This case emphasizes the importance of understanding and recognizing pharmacologic causes, such as muscarinic receptor antagonism, in the differential diagnosis of mydriasis. It also underscores the need for continuous reassessment during transport and the potential for cognitive biases to influence decision-making.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 111-113"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Air Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1067991X24002256","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Nursing","Score":null,"Total":0}
引用次数: 0

Abstract

This case report describes the medical management for a 14-year-old female patient who suffered cardiac arrest following an acute asthma exacerbation. During air medical transport, the patient developed unilateral mydriasis, a concerning finding often associated with intracranial pathology such as cerebral herniation. Immediate interventions included the administration of hypertonic saline and targeted ventilation strategies to maintain end-tidal carbon dioxide levels within a therapeutic range. Subsequent diagnostic evaluation, including imaging, revealed no neurologic abnormalities, and the mydriasis resolved spontaneously without complications. Ophthalmic ipratropium exposure was suspected as the underlying cause. This case emphasizes the importance of understanding and recognizing pharmacologic causes, such as muscarinic receptor antagonism, in the differential diagnosis of mydriasis. It also underscores the need for continuous reassessment during transport and the potential for cognitive biases to influence decision-making.
直升机紧急医疗服务中的单侧瞳孔:儿童哮喘性心脏骤停时眼用异丙托品暴露促使脑疝预防的一例
本病例报告描述了一名14岁女性患者在急性哮喘发作后心脏骤停的医疗管理。在空中医疗运输过程中,患者出现单侧瞳孔肿大,这一令人担忧的发现通常与颅内病理(如脑疝)有关。即时干预措施包括给予高渗盐水和有针对性的通气策略,以维持潮末二氧化碳水平在治疗范围内。随后的诊断评估,包括影像学检查,显示无神经系统异常,睑下垂自行消退,无并发症。眼科异丙托品暴露被怀疑是潜在原因。本病例强调理解和认识药理学原因的重要性,如毒蕈碱受体拮抗剂,在鉴别诊断中。它还强调需要在运输过程中不断进行重新评估,以及认知偏差可能影响决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Air Medical Journal
Air Medical Journal Nursing-Emergency Nursing
CiteScore
1.20
自引率
0.00%
发文量
112
审稿时长
69 days
期刊介绍: Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信