Buylaert W A
Department of Emergency Medicine, University Hospital, Gent, Belgium.
Acta Neurol Belg. 2000 Dec;100(4):221-4.
Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only when clinically indicated and in a titrated way. Flumazenil should only be used with caution and in restricted cases. Clinical neurological evaluation and technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. Toxicological tests deserve their place in the diagnostic work up of a coma patient with suspected poisoning. Knowledge of the possibilities of the toxicology lab and optimal communication with the clinical toxicologist is important for optimal patient care.
急诊科的临床医生经常会遇到因中毒导致的昏迷患者。采取一种系统的总体方法，包括尽早咨询神经科医生，这至关重要。高度的怀疑指数、在院前阶段就进行系统的首次评估以及尽早稳定生命功能是必不可少的首要步骤。诸如高渗葡萄糖和硫胺素等特效解毒剂是“昏迷合剂”的一部分。阿片类拮抗剂纳洛酮仅在临床有指征时且需滴定使用。氟马西尼仅应谨慎使用且限于特定情况。临床神经学评估以及如CT扫描和实验室检查等技术调查应成为仔细诊断计划的一部分。毒理学检测在疑似中毒昏迷患者的诊断检查中应有一席之地。了解毒理学实验室的检测能力并与临床毒理学家进行最佳沟通对于为患者提供最佳护理很重要。
