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Titolo:
THE POISONED PATIENT WITH ALTERED CONSCIOUSNESS - CONTROVERSIES IN THE USE OF A COMA COCKTAIL
Autore:
HOFFMAN RS; GOLDFRANK LR;
Indirizzi:
NYU,MED CTR,BELLEVUE HOSP CTR,NEW YORK CITY POISON CONTROL CTR,BUR LABS,462 1ST AVE,ROOM GN-22 NEW YORK NY 10016 NYU,MED CTR,BELLEVUE HOSP CTR,NEW YORK CITY POISON CONTROL CTR,BUR LABS NEW YORK NY 10016 NEW YORK CITY DEPT HLTH NEW YORK NY 10013
Titolo Testata:
JAMA, the journal of the American Medical Association
fascicolo: 7, volume: 274, anno: 1995,
pagine: 562 - 569
SICI:
0098-7484(1995)274:7<562:TPPWAC>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
HIGH-DOSE NALOXONE; TRICYCLIC ANTIDEPRESSANT OVERDOSE; INDUCED RESPIRATORY DEPRESSION; WERNICKE-KORSAKOFF SYNDROME; INDUCED PULMONARY-EDEMA; CENTRAL NERVOUS-SYSTEM; ISCHEMIC BRAIN-DAMAGE; BLOOD-GLUCOSE LEVELS; SPINAL-CORD INJURY; BENZODIAZEPINE ANTAGONIST;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
150
Recensione:
Indirizzi per estratti:
Citazione:
R.S. Hoffman e L.R. Goldfrank, "THE POISONED PATIENT WITH ALTERED CONSCIOUSNESS - CONTROVERSIES IN THE USE OF A COMA COCKTAIL", JAMA, the journal of the American Medical Association, 274(7), 1995, pp. 562-569

Abstract

Objective.-In the assessment and management of the potentially poisoned patient with altered consciousness, the most consequential and controversial interventions occur during the first 5 minutes of care. In this review article, the risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making. Data Sources.-Data for discussion were obtained from a search of English-language publications referenced on MEDLINE for the years 1966 to 1994. Older literature was included when pertinent. Search terms included poisoning, overdose, toxicity, naloxone, glucose, thiamine, and flumazenil. Study Selection.-Only large trials were used for determinations of diagnostic utility and efficacy. Small trials, case series, and case reports were reviewed extensively for adverse effects. Data Extraction and Synthesis.-Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcome. Conclusion.-Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 10/04/20 alle ore 13:46:43