意識が変化した中毒患者. "コマカクテル"の使用に関する論争
1New York University Medical Center, Bellevue Hospital Center 10016, USA.
JAMA
|August 16, 1995
まとめ
意識の変化に対してデクストロースとチアミンを経験的に投与する. オピオイド中毒に対するリザーブナロクソン,ベンゾジアゼピン過剰投与または鎮静作用の逆転に対するフルマゼニル.
科学分野:
- 緊急医療 緊急医療
- 臨床毒理学について
背景:
- 毒を飲んだ患者の意識の変化は,重要な早期介入を必要とします.
- 標準的な診断および治療方法には,リスクと利点があります.
研究 の 目的:
- 潜在的に中毒された意識の変化患者に対する標準的な介入のリスクと利益を見直す.
- 診療の最初の5分間の重要な意思決定において臨床医を指導するためです.
主な方法:
- MEDLINE (1966-1994) の文献検索は,中毒,過剰摂取,毒性,ナロキソン,グルコース,チアミン,フルマゼニルといった用語を用いて行われました.
- 診断の有用性と有効性に関する大規模な試験の分析.
- 副作用に関する小規模な研究の広範なレビュー.
主要な成果:
- ハイパートニックデクストロースとチアミン塩化水素の経験的投与は,意識の変化に対して好ましい.
- ラピッド・グルコース・テスト・ストリップは,低血糖症の検出には有用ですが,不誤ではありません.
- ナロキソン塩化水素は,オピオイド中毒の治療に用いる.
- フルマゼニルは,治療的な意識的な鎮静剤の逆転およびベンゾジアゼピン過剰投与を選択するために推奨されます.
結論:
- デクストロースとチアミンによる早期の経験的治療は,意識の変化に対して有益である.
- ナロキソンとフルマゼニルの賢明な使用は,特定の臨床プレゼンテーションに基づいて決定的です.
- 臨床医は,初期管理段階で介入のリスクと利益を考慮する必要があります.
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