Acute care for alcohol intoxication

Yost, David

doi:10.3810/pgm.2002.12.1361

Cited by 31 publications

(13 citation statements)

References 12 publications

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“…The management of ethanol, opioid, benzodiazepine, GHB and central stimulant poisoning is well established [ 16 – 22 ]. There has been some controversy about how long patients need observation, especially patients treated with naloxone for opioid overdose.…”

Section: Discussionmentioning

confidence: 99%

“…Patients observed at the OAEOC are hospitalised if they do not regain full consciousness within 4 h. The 4-h limit was set as patients poisoned by ethanol or heroin, the two most frequent toxic agents, should be awake and recovering by this time. If not awake or if confusion persists, other conditions must be suspected, most of them beyond the scope of what can be managed in the outpatient setting [ 15 , 16 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Vallersnes

Jacobsen

Ekeberg

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundProcedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC).MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry.ResultsThere were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries.ConclusionThe procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Vallersnes

Jacobsen

Ekeberg

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…normal saline in many EDs around the world 6,7. Justification for its use should be explored to ascertain that the health and economic benefits outweigh the potential harms (such as infection and fluid overload8).…”

Section: Introductionmentioning

confidence: 99%

Intravenous 0.9% sodium chloride therapy does not reduce length of stay of alcohol‐intoxicated patients in the emergency department: A randomised controlled trial

Perez

Keijzers

Steele

et al. 2013

Emerg Medicine Australasia

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“…This is a considerable risk due to the high incidence of alcohol inebriated patients and since some of the more common pathological conditions in emergency medicine can introduce a behaviour that resembles the behaviour of a person under the influence of alcohol, e.g. brain and head injuries, psychomotor seizures, acute or diagnosed physiological illness, carbon dioxide narcosis, and acute hypo-glycemia [6,7,11,20,22,27]. With determination of the blood or breath alcohol concentration the risk of relying on a suspicion of involvement of alcohol would be eliminated in the medical assessment.…”

Section: Introductionmentioning

confidence: 99%

Improved breath alcohol analysis in patients with depressed consciousness

Andersson¹,

Hök²,

Rentsch

et al. 2010

Med Biol Eng Comput

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Many patients in pre-hospital and emergency care are under the influence of alcohol. In addition, some of the more common pathological conditions can introduce a behaviour that can be mistaken to be related to alcohol inebriation. Fast quantitative determination of the breath alcohol concentration (BrAC) in emergency patients facilitates triage and medical assessment, but shallow expirations performed by non-cooperative patients reduce the measurement reliability. The aim of this study was to evaluate if breath alcohol analysis in non-cooperative patients can be improved with use of simultaneous measurement of the expired carbon dioxide (CO(2)). With prototypes of a handheld breath alcohol analyser based on infrared transmission spectroscopy the alcohol and CO(2) concentration in expired breath from 37 cooperative and non-cooperative patients were measured. The results show that enhanced breath sampling with use of a pump and estimation of the end expiratory BrAC with use of the ratio between the measured partial pressure of CO(2) (PCO2) and a reference value of the alveolar PCO2, provided adequate correlation with the blood alcohol concentration (BAC). This pre-clinical study has shown that breath alcohol analysis in shallow expirations from non-cooperative patients can be improved with use of CO(2) as a tracer gas.

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Acute care for alcohol intoxication

Cited by 31 publications

References 12 publications

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Intravenous 0.9% sodium chloride therapy does not reduce length of stay of alcohol‐intoxicated patients in the emergency department: A randomised controlled trial

Improved breath alcohol analysis in patients with depressed consciousness

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