The pharmacokinetics of intraosseous atropine in hypovolemic swine.

OBJECTIVE: Compare the pharmacokinetics of atropine administered via the intravenous (IV), intramuscular (IM), and intraosseous (IO) routes in a normovolemic and hypovolemic swine model. DESIGN: Prospective, between subjects, experimental study. SETTING: Vivarium. SUBJECTS: Yorkshire-cross swine (N = 36). INTERVENTION: Atropine was administered via IV, IM, or IO routes to normovolemic and hypovolemic swine. Blood samples were drawn at regular intervals after atropine administration and analyzed for plasma atropine concentration. Pharmacokinetic parameters were obtained from modeling the plasma concentrations. MAIN OUTCOME MEASUREMENTS: Pharmacokinetic parameters, maximum concentration (Cmax) and time to maximum concentration (Tmax). RESULTS: The IV and IO groups in both the normovolemic and hypovolemic models reached peak plasma concentration immediately and had a very rapid distribution phase with no apparent absorption phase for the IO groups. Peak plasma concentration and time to reach peak concentration were both significantly lower for the IM groups. There was a significant increase in absorption time with IM administration in the hypovolemic model compared to the normovolemic model. CONCLUSION: The IO route is an effective method of administering atropine and is comparable to the IV route even under conditions of significant hemorrhage. Therapeutic levels of atropine may be delayed and possibly difficult to obtain via IM injection in the presence of hypovolemic shock.

Sevoflurane as a therapy for acute chlorine gas exposure in an austere healthcare environment: a case report.

Chlorine is a common agent found worldwide in industrial and household applications. This element is found everywhere and anywhere around the globe. Because of its ubiquitous nature in the world, chlorine-injured patients may be expected at all medical facilities, from large-urban to small-community to austere-tent facilities. Chlorine has been used as a chemical weapon since 1915 and has been accidentally released in transport, storage, and use, causing industrial accidents worldwide. A patient with a history of severe chlorine inhalational injury sustained 2 chlorine gas exposures within 48 hours. The patient was treated with intubation, mechanical ventilation, and directed therapies for severe injury by chlorine gas inhalation. Sevoflurane has a role in treating chlorine inhalation injury. Additional therapies are possible, some of which are not available in remote locations.