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2010, vol. 138, br. 3-4, str. 210-213
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Glazgovska koma-skala kod akutnih trovanja pre i posle primene protivotrova kod bolesnika koji su uzimali psihotropne agense
Glasgow coma scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents
aDepartment of Family Medicine, Ljubljana, Slovenia bDepartment of Family Medicine, Maribor, Slovenia cDepartment of Family Medicine, Ljubljana, Slovenia + Department of Family Medicine, Maribor, Slovenia
e-adresa: janko.kersnik@ozg-kranj.si
Sažetak
Uvod. Malo je podataka o hitnim intervencijama kod trovawa. Cilj rada. Cilj rada je bio da se odredi efikasnost protivotrova kod hitnih intervencija vezanih za trovanje. Metode rada. Prospektivna opservaciona studija obuhvatila je sve slučajeve intervencija povezanih s trovanjem tokom tri godine (1999-2001) u regionu Celja, u Sloveniji, gde živi 125.000 stanovnika. Podaci su zabeleženi u formularu Službe za hitne intervencije. Rezultati. Psihoaktivni agensi su bili uzrok 56,5% hitnih intervencija povezanih s trovanjem od ukupno 244. Lekovi na recept bili su uzrok trovanja u 93 slučaja (39,2%), bilo sami za sebe, bilo u kombinaciji s alkoholom ili nedozvoljenim supstancama. U 52 slučaja (21,9%) trovanje se desilo usled uzimanja nedozvoljenih supstanci, od čega su 43 (18,1%) bila povezana s heroinom. U vreme dolaska službe hitne medicinske pomoći nekoliko bolesnika koji su udisali nedozvoljene supstance bilo je u komi ili komatoznom stanju. Od 32 otrovane osobe (17,3%), 24 (45,3%) su bile u komi (p<0,001). Vrednosti na Glazgovskoj koma-skali (Glasgow Coma Scale; GKS) pri prvom kontaktu bile su niže kod bolesnika koji su udisali nedozvoljene supstance nego kod ostalih (9,0 prema 11,6; p=0,001). U 23,2% slučaja dat je protivotrov. Kod 29 bolesnika (12,2%) primenjen je nalokson, a kod 16 (6,7%) flumazenil. Srednja vrednost skora na GKS posle intervencije bila je veća u svim slučajevima, ali značajno veća kod osoba koje su uzimale nedozvoljene supstance (13,4 prema 12,2; p=0,001); srednja pozitivna promena skora bila je 4,5 u odnosu na 0,6 (p<0,001). Kod korisnika nedozvoljenih supstanci srednja promena posle primene protivotrova bila je 8,2, a kod bolesnika kojima protivotrov nije dat 0,5 (p<0,001). Zaključak. Visoka stopa uspešne primene protivotrova tokom intervencije pokazala je značaj dobrih protokola službe hitne medicinske pomoći i prisustva obučenog doktora u timu ove službe.
Abstract
Introduction. Data on emergency interventions in poisonings are scarce. Objective. To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions. Methods. A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. Results. Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p<0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p=0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p=0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p<0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p<0.001). Conclusion. High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.
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