Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- history of opioid use disorder and dependence
- miosis
- bradypnea
- altered mental status
- dramatic response to naloxone
Otros factores de diagnóstico
- fresh needle marks
- drug paraphernalia nearby
- decreased gastrointestinal motility
- old track marks on arms and legs
- pulmonary rales
- frothy pink sputum
- seizures
- dysrhythmias
Factores de riesgo
- history of prescribed opioids
- opioid use disorder and dependence
- recent abstinence in chronic users
- taking opioids by injection
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- therapeutic trial of naloxone
- Electrocardiogram (ECG)
Pruebas diagnósticas que deben considerarse
- chest x-ray
- abdominal CT scan
- abdominal x-ray
- opioid urine screen
- gas chromatography/ mass spectrometry
Algoritmo de tratamiento
without retained drug packages
with retained drug packages
Colaboradores
Autores
Ruben Thanacoody, MD, FRCP, FRCP(Edin), FEAPCCT
Consultant Physician and Clinical Toxicologist
Director, National Poisons Information Service (Newcastle)
Honorary Clinical Senior Lecturer, Newcastle University
Newcastle-upon-Tyne
UK
Divulgaciones
RT declares that he has no competing interests. RT is an author of a reference cited in this topic.
Agradecimientos
Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.
Divulgaciones
DO declares that he has no competing interests.
Revisores por pares
Joseph Donroe, null
Associate Professor of Medicine
Yale School of Medicine
New Haven
CO
Divulgaciones
JD declares that he has no competing interests.
Anne-Maree Kelley, MD, MClinEd, FACEM
Director
Joseph Epstein Centre for Emergency Medicine Research
Western Health Sunshine Hospital
St Albans
Australia
Divulgaciones
AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.Texto completo Resumen
Dezfulian C, Orkin AM, Maron BA, et al. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021 Apr 20;143(16):e836-70.Texto completo Resumen
Resuscitation Council UK. 2021 resuscitation guidelines. 2021 [internet publication].Texto completo
Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019 Nov-Dec;23(6):749-63.Texto completo Resumen
Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL) overdose
- Clonidine/imidazolines overdose
- Antipsychotic overdose
Más DiferencialesGuías de práctica clínica
- Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department
- 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
Más Guías de práctica clínicaInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad