O álcool na Clínica Médica

Padrões mínimos para assistência de enfermagem segura a usuários de bebidas alcoólicas Minimum standards for safe nursing care for users of alcoholic beverages

“…7 The alcohol can produce disorders to physical and mental health of users, development of infectious processes, metabolic disorders and accidents, which sometimes show up more urgent than intoxication or alcohol syndrome per se, as evidenced by the significant increase in demand in hospital units by alcoholics. [18][19] Complications related to the lack of standardization in service provided to users of alcohol in emergency rooms are a recurring fact. The spread, diversification and availability of psychoactive substances pose health professionals against various clinical conditions, alone or combined, minimized, exaggerated or masked by other conditions.…”

“…These users are more susceptible to accidents and violence, and alcoholic poisoning can generate suicidal tendencies or function as 'antidotes' for individuals who suffer from some psychiatric pathology. 19 During the admission to the emergency room, patients often refuse care in such rooms, as they are commonly taken against their will, and have difficulty in maintaining a confidential relationship in an open environment in which nurses, doctors, security guards, rescuers, other patients and patients companions interact simultaneously. 4 …”

“…In such units is present pronounced poisoning with increasing levels of central nervous system depression, behavioral changes -agitation, anxiety states and/or depression, aggressiveness, disorientation, confusion, and psychomotor impairment -slurred speech, impaired motor performance, lethargy, ataxia, usually associated with clinical signs and major symptoms. 13,19 Acute poisoning is fleeting, the human body metabolizes about 0.015mg% of alcohol/hour, or about one unit of alcohol (10 g/hour), but in the emergency units is received a large number of complications related to the continued use and/or abuse or discontinuation of alcohol in chronic users (withdrawal syndrome). 11,21 Toxic doses vary from each case; the speed of ingestion, food intake, concomitant use of other psychoactive substances, environmental factors and the development of individual tolerance to the effects of alcohol interfere in this relation.…”

“…11,13 Special attention to patients who used alcohol in binge drinking, defined as the consumption of five or more doses of alcohol on a single occasion for men or four or more for women. 4,19 The symptoms will depend on the serum levels of alcohol and the patient's tolerance: 50-150 mg/dL -verbiage, diminished reflexes, blurred vision, excitement or mental depression; 150-300 mg/dL -ataxia, confusion, hypoglycemia (especially in children), logorrhea; 300-500 mg/dL -marked incoordination, stupor, hypothermia, hypoglycemia (seizures), electrolyte disturbances with hyponatremia, hypercalcemia, hypomagnesemia, hypophosphatemia and metabolic acidosis; and> 500 mg/dl -coma and respiratory and/or circulatory failure can lead to death. 21 The guidelines for the treatment of disorders related to the use of substances of the American Psychiatric Association -APA indicate the handling of intoxication with the following objectives: to promote, for intoxicated patients, decreased exposure to external stimuli; to provide secure and monitored environment; to investigate the substances used and the entry route, dose, exposure time, and if the level of intoxication is increasing or decreasing; removing the toxic substances from the body (decontamination or increased excretion rate); to reverse the effects of the substance by the administration of antagonists, if there are some; using approaches to stabilize the physical effects of overdoseintubation to reduce the risk of bronchial aspiration, drugs to maintain blood pressure in satisfactory levels.…”

“…Bruises may indicate trauma during intoxication or coagulation disorders induced by liver failure. 4,13,19 To remove residual alcohol and to prevent vomit followed by pulmonary aspiration, decontamination measures can be prescribed, according to the route of introduction of the toxic agent in the body. Although there are few studies on gastric emptying procedures in the medical literature, it is well established that after 60 minutes very little or nothing of the ingested dose is removed by gastric lavage and there are proposals of treatment protocols with strong restrictions on general indication of gastrointestinal decontamination measures.…”