Wolf Stephen J, Heard Kennon, Sloan Edward P, Jagoda Andy S
J Emerg Nurs. 2008 Apr;34(2):e1-18. doi: 10.1016/j.jen.2008.02.004.
This clinical policy focuses on critical issues concerning the management of patients presenting to the emergency department (ED) with acetaminophen overdose. The subcommittee reviewed the medical literature relevant to the questions posed. The critical questions are: 1. What are the indications for N-acetylcysteine (NAC) in the acetaminophen overdose patient with a known time of acute ingestion who can be risk stratified by th Rumack-Matthew nomogram? 2. What are the indications for NAC in the acetaminophen overdose patient who cannot be risk stratified by the Rumack-Matthew nomogram? Recommendations are provided on the basis of the strength of evidence of the literature. Level A recommendations represent patient management principles that reflect a high degree of clinical certainty; Level B recommendations represent patient management principles that reflect moderate clinical certainty; and Level C recommendations represent other patient management strategies that are based on preliminary, inconclusive, or conflicting evidence, or based on committee consensus. This guideline is intended for physicians working in EDs.
本临床政策聚焦于对因对乙酰氨基酚过量而前往急诊科（ED）就诊患者进行管理的关键问题。小组委员会审查了与所提出问题相关的医学文献。关键问题如下：1. 对于已知急性摄入时间且可通过鲁马克-马修 nomogram 进行风险分层的对乙酰氨基酚过量患者，N-乙酰半胱氨酸（NAC）的使用指征是什么？2. 对于无法通过鲁马克-马修 nomogram 进行风险分层的对乙酰氨基酚过量患者，NAC 的使用指征是什么？根据文献证据的强度给出了建议。A级建议代表反映高度临床确定性的患者管理原则；B 级建议代表反映中度临床确定性的患者管理原则；C 级建议代表基于初步、不确定或相互矛盾的证据或基于委员会共识的其他患者管理策略。本指南适用于在急诊科工作的医生。
