Caffrey Charles R, Lank Patrick M
Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Open Access Emerg Med. 2017 Dec 20;10:9-23. doi: 10.2147/OAEM.S120120. eCollection 2018.
Patients can use numerous drugs that exist outside of existing regulatory statutes in order to get "legal highs." Legal psychoactive substances represent a challenge to the emergency medicine physician due to the sheer number of available agents, their multiple toxidromes and presentations, their escaping traditional methods of analysis, and the reluctance of patients to divulge their use of these agents. This paper endeavors to cover a wide variety of "legal highs," or uncontrolled psychoactive substances that may have abuse potential and may result in serious toxicity. These agents include not only some novel psychoactive substances aka "designer drugs," but also a wide variety of over-the-counter medications, herbal supplements, and even a household culinary spice. The care of patients in the emergency department who have used "legal high" substances is challenging. Patients may misunderstand the substance they have been exposed to, there are rarely any readily available laboratory confirmatory tests for these substances, and the exact substances being abused may change on a near-daily basis. This review will attempt to group legal agents into expected toxidromes and discuss associated common clinical manifestations and management. A focus on aggressive symptom-based supportive care as well as management of end-organ dysfunction is the mainstay of treatment for these patients in the emergency department.
患者可以使用许多现有监管法规之外的药物来获得“合法的快感”。合法的精神活性物质给急诊医学医生带来了挑战，这是因为可用药物数量众多、具有多种中毒综合征和表现形式、能逃避传统分析方法，以及患者不愿透露他们使用这些药物的情况。本文致力于涵盖各种各样的“合法快感”药物，即可能具有滥用潜力并可能导致严重毒性的不受管制的精神活性物质。这些药物不仅包括一些新型精神活性物质，也就是所谓的“设计药物”，还包括各种各样的非处方药、草药补充剂，甚至一种家用烹饪香料。在急诊科护理使用过“合法快感”物质的患者具有挑战性。患者可能误解他们接触到的物质，针对这些物质几乎没有任何现成的实验室确诊检测方法，而且被滥用的确切物质可能几乎每天都在变化。本综述将尝试把合法药物归类到预期的中毒综合征中，并讨论相关的常见临床表现及处理方法。在急诊科，对这些患者的治疗主要依靠积极的基于症状的支持性护理以及对终末器官功能障碍的处理。
