Cardiorespiratory compromise

CSF examination via lumbar puncture (LP, spinal tap) contraindicated in patients with cardiorespiratory compromise,... 

A casualty with severe cardiorespiratory compromise when treatment or evacuation resources are unavailable. 

Cardiorespiratory compromise such that safe sedation or anesthesia cannot be accomplished... 

The antidote, physostigmine, can be used and is safe and effective if used properly. It is most effective after 4 hours from time of exposure, although effects from a single intramuscular injection of physostigmine last only about 60 minutes, requiring frequent re-dosing. Corrective resuscitative measures should take place primarily and it should not be used in a patient with cardiorespiratory compromise, hypoxia, or acid-base imbalance with a history of seizure disorders or arrhythmias. 

Use with caution in oider patients with Hepatic impairment. Impaired renal function, CHF, Compromised cardiorespiratory function. Untreated vitamin B,2 deficiency, Increased liver function tests (ALT, AST)... 

Ritonavir is an inhibitor of HIV protease and a potent inhibitor of CYP3A4 and CYP2D6. The interaction between ritonavir and intravenous fentanyl has been investigated in 12 healthy volunteers in a double-blind, placebo-controUed, crossover study (84). The volunteers took ritonavir 600 mg on day 1, ritonavir 900 mg and intravenous fentanyl 5 pg/kg on day 2, and ritonavir 300 mg or placebo on day 3. Ritonavir reduced the clearance of fentanyl by 67% by inhibiting its metabolism. This could result in prolongation of fentanyl-induced respiratory depression in a patient with an aheady compromised cardiorespiratory system. 

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