Intubation for patients with overdose: Time to move on from the Glasgow Coma Scale.

Autor: Pellatt RA; Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.; LifeFlight Retrieval Medicine, LifeFlight Australia, Brisbane, Queensland, Australia.; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia., Isoardi K; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Emergency Department, Princess Alexandria Hospital, Brisbane, Queensland, Australia., Keijzers G; Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
Jazyk: angličtina
Zdroj: Emergency medicine Australasia : EMA [Emerg Med Australas] 2023 Aug; Vol. 35 (4), pp. 702-705. Date of Electronic Publication: 2023 May 29.
DOI: 10.1111/1742-6723.14254
Abstrakt: Patients frequently present to the ED with drug overdose and reduced conscious level leading to coma. There is considerable practice variation around which patients require intubation. Indications include: (i) respiratory failure (including airway obstruction); (ii) to facilitate specific therapies or intubation as a therapy in itself; and (iii) for airway protection in the unprotected airway. We argue that intubating a patient purely for (iii) is outdated and that most patients can be safely observed. There is a paucity of good quality research in the area of drug overdose with reduced consciousness. Teaching may be outdated and based on the use of the Glasgow Coma Scale in head trauma. Current low quality research suggests observation is safe. We recommend that patients undergo an individualised risk assessment of the need for intubation. We propose a flow diagram to aid clinicians in safely observing comatose overdose patients. This can be applied if the drug is unknown, or there are multiple drugs involved.
(© 2023 Australasian College for Emergency Medicine.)
Databáze: MEDLINE
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