Dissanayake Vinodinee, Dalka Erin T, Koh Cynthia, Bisanzo Mark, Brandt Ryan S, Erickson Timothy B, Chamberlain Stacey
Department of Emergency Medicine, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, United States.
Department of Emergency Medicine, Cook County Hospital (Stroger), United States.
Afr J Emerg Med. 2018 Mar;8(1):25-28. doi: 10.1016/j.afjem.2017.11.002. Epub 2018 Jan 19.
The Global Emergency Care Collaborative and Nyakibale Hospital in Rukungiri opened the first functional emergency centre in rural Uganda. We investigated decontamination, management and outcomes of poisoned patients in the emergency centre.
An electronic database started recording charts from 24 March 2012. A search for diagnoses concerning self-poisoning was performed from 24 March 2012 to 30 December 2013 and 192 charts were found and de-identified. Data collection included: age, sex, poison and duration, intent, vital signs, physical examination, decontamination, antidote use and follow-up status.
From 24 March 2012 to 30 December 2013 poisoning accounted for 96 patient encounters. Of these, 33 were associated with alpha-2 agonists and 16 were associated with organophosphorous or carbamate pesticides. The post-decontamination fatality rate was 5.7%. The fatality rate of those without decontamination was 8.3%. Of those who were given atropine, 38.8% had no known indication. Of the 96 patient encounters, there were seven deaths; six were due to pesticides.
In resource-limited settings where antidotes and resuscitative capabilities are scarce, decontamination needs to be studied further. Repeat atropine use without indication may lead to depletion of an essential antidote. Future directions include a public health education programme and an algorithm to help guide clinical decisions.
全球急诊护理协作组织与鲁昆吉里的尼亚基巴莱医院在乌干达农村地区开设了首个功能完备的急救中心。我们对该急救中心中毒患者的去污处理、管理及治疗结果进行了调查。
一个电子数据库于2012年3月24日开始记录病例。对2012年3月24日至2013年12月30日期间有关自我中毒的诊断进行检索，共找到192份病例并进行了去识别处理。数据收集内容包括：年龄、性别、毒物及接触时长、中毒意图、生命体征、体格检查、去污处理、解毒剂使用及随访状况。
2012年3月24日至2013年12月30日期间，共有96例中毒患者前来就诊。其中，33例与α-2激动剂有关，16例与有机磷或氨基甲酸酯类农药有关。去污处理后的死亡率为5.7%。未进行去污处理的患者死亡率为8.3%。在使用阿托品的患者中，38.8%无明确使用指征。96例就诊患者中，有7例死亡；6例死于农药中毒。
在解毒剂和复苏能力匮乏的资源有限环境中，去污处理需要进一步研究。无指征重复使用阿托品可能导致关键解毒剂的耗竭。未来的方向包括开展公共卫生教育项目以及制定有助于指导临床决策的算法。
