Vazirian Mohsen, Jerry Jason M, James Jeffrey, Dale Roman M
From the Department of Psychiatry and Psychology (MV, JMJ, RMD), the Cle-veland Clinic Foundation, Cleveland, OH; Cleveland Clinic Lerner College of Medicine (JMJ, RMD), Cleveland, OH; Alcohol and Drug Recovery Center (JMJ), the Cleveland Clinic Foundation, Cleveland, OH; and Case Western Reserve University School of Medicine (JJ), Cleveland, OH.
J Addict Med. 2015 Mar-Apr;9(2):94-8. doi: 10.1097/ADM.0000000000000094.
Several novel synthetic amphetamines have been marketed worldwide as "bath salts." The use of bath salts is associated with severe medical consequences resulting in a US federal ban over the last 3 years on the more common substances found in this group. Bath salts intoxication has a relatively nonspecific presentation, and urine toxicology confirmation in emergency departments (EDs) is impractical because the turnaround time is several days. Emergency clinicians must therefore rely heavily on patients' self-reports to verify the diagnosis. We performed an online survey of emergency clinicians to determine their degree of exposure to bath salts-intoxicated patients, the clinically relevant features of such patients, and the typical emergency management.
We invited 124 physicians and physician assistants in 7 Cleveland Clinic EDs to participate in an online survey.
From a total of 43 of the 124 respondents, 77% did not specifically ask patients about bath salts use. Sixty percent had encountered a bath salts-intoxicated individual. Most respondents reported that the majority of patients were male, were between 19 and 29 years old, and used other drugs in addition to bath salts. Agitation, aggression/violence, and hallucinations were reported to be the most common presentations, and intravenous/intramuscular tranquilization was reported as the most often used management. Most patients were discharged home from the ED.
Despite the lack of toxicology screening in EDs, about two thirds of the surveyed emergency clinicians encountered bath salts-intoxicated individuals. Our study demonstrates the need for increased screening of bath salts intoxication in EDs, especially in agitated patients.
几种新型合成苯丙胺类药物在全球作为“浴盐”销售。使用浴盐会带来严重的医学后果，导致美国联邦政府在过去三年对该类中更常见的物质实施了禁令。浴盐中毒的表现相对不具特异性，在急诊科进行尿液毒理学确认不切实际，因为周转时间需要数天。因此，急诊临床医生必须严重依赖患者的自我报告来核实诊断。我们对急诊临床医生进行了一项在线调查，以确定他们接触浴盐中毒患者的程度、此类患者的临床相关特征以及典型的急诊处理方法。
我们邀请了克利夫兰诊所7个急诊科的124名医生和医师助理参与一项在线调查。
在124名受访者中，共有43人回复，77%的人没有专门询问患者是否使用过浴盐。60%的人遇到过浴盐中毒的个体。大多数受访者报告说，大多数患者为男性，年龄在19至29岁之间，除浴盐外还使用其他药物。据报告，躁动、攻击/暴力和幻觉是最常见的表现，静脉内/肌内注射镇静剂是最常用的处理方法。大多数患者从急诊科出院回家。
尽管急诊科缺乏毒理学筛查，但约三分之二接受调查的急诊临床医生遇到过浴盐中毒的个体。我们的研究表明，急诊科需要加强对浴盐中毒的筛查，尤其是对躁动患者。
